Violence in Families: Integrating Research into Practice (Advances in Preventing and Treating Violence and Aggression) [1st ed. 2023] 3031315480, 9783031315480

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Advances in Preventing and Treating Violence and Aggression

Peter Sturmey   Editor

Violence in Families Integrating Research into Practice

Advances in Preventing and Treating Violence and Aggression Series Editor Peter Sturmey, Queens College and The Graduate Center City University of New York Flushing, NY, USA

The series publishes books focused and developed across three domains. The first is understanding and explaining violence and aggression. Books in this domain address such subject matter as genetics, physiology, neurobiology, cultural evolution, biobehavioral, learning, cognitive, psychoanalytic, sociological and other explanations of violence. The second domain focuses on prevention and treatment for individuals and couples. Examples of books in this domain include cognitive behavioral, behavioral, counseling, psychopharmacological, psychosocial, couples, and family therapy approaches. They also explore extant treatment packages for individually focused treatments (e.g., mindfulness, cognitive analytic therapies). Within this domain, books focus on meeting the information needs of clinicians and professionals who work in youth facilities, emergency rooms, special education, criminal justice, and therapy settings. Finally, books in the third domain address prevention and treatment for groups and society, including topical focus on early intervention programs, school violence prevention programs, policing strategies, juvenile facility reform as well as socio-legal and ethical issues. Books in this series serve as must-have resources for researchers, academics, and upper-level undergraduate and graduate students in clinical child and school psychology, public health, criminology/criminal justice, developmental psychology, psychotherapy/ counseling, psychiatry, social work, educational policy and politics, health psychology, nursing, and behavioral therapy/rehabilitation.

Peter Sturmey Editor

Violence in Families Integrating Research into Practice

Editor Peter Sturmey Queens College and The Graduate Center City University of New York Flushing, NY, USA

Advances in Preventing and Treating Violence and Aggression ISBN 978-3-031-31548-0    ISBN 978-3-031-31549-7 (eBook) https://doi.org/10.1007/978-3-031-31549-7 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

To the memory of my parents

Preface

When we think of violence, we often think of a few individuals who have mental health or other problems – the desperate thief who needs food and money, the person with schizophrenia, the psychopath, the person who is out of control and drunk or high on drugs, the gang of juvenile deviants who have dropped out of mainstream society, the hidden serial killer, and the evil person who enjoys seeing people suffering. But usually, most of us do not think of our nearest and dearest, the people we live with, and who love us and whom we love. We are tied to the image of the loving, nuclear family that stays together through thick and thin, who are mutually loyal, and who protect each other from outside violence. The truth is much less palatable. It seems that the family is indeed, as Steinmetz and Struas (1973) called it, the cradle of violence, rather than the nest of love. Violence from heterosexual male partners to heterosexual females partners is common and sometimes lethal, but we should not also forget the less common violence from women to men in heterosexual relationships. Violence from parents and other adult caregivers to children, which again is sometimes lethal, is common. Some adolescents are also violent to their parents, and violence to seniors within the family from various other family members also occurs. Violence also occurs in gay families and lesbian families with no adult male members. This volume addresses three aspects of this problem. The first is defining, measuring and documenting family violence, its extent, costs, impacts on family members and society generally, and risk factors that may inform prevention and treatment. The second is explaining this paradoxical phenomenon that costs everyone so much. There is a perplexing and very wide range of explanations of family violence which sometimes seem incompatible, but sometimes approaches which at first glance seem theoretically and ideologically incompatible end us as strange bedfellows. Finally, there is the question of what to do to prevent or treat family violence. Again approaches are very varied and range from therapy or other interventions for the perpetrators, dyad, or entire family. Other intervention approaches have focused on the roles that law enforcement, courts, the justice system and national policies more generally can play in prevention and treatment.

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Volume Overview In order to address family violence, one must first be clear as to what constitutes a family. This question probably never was clear, but today is certainly not clear. Hence, the first chapter by Barbara Settles on defining families outlines the issues in defining the family unit. Is the family a group of cohabiting, married people related by blood and legal ties, other cohabiting groups with legal ties, self-identifying groups of people, people perceived to be a family unit by others, or the place of last refuge when no-one else will take us in? As well as defining family, once has to define violence. Chapter 2 by Bagwell-Gray, Messing, Ogbonnaya, and Brown addresses the measurement issue within the context of intimate partner violence in the USA. They address measuring family violence using new technologies, sexual violence, and, child abuse using state databases. As a generalization, men are violent much more often than women and often to female victims. This widely recognized feature of family violence has generated much interest as to how to explain this phenomenon. (Some of the difficult questions regarding the validity of self-­ reported measures of violence are also addressed in Perry and Daly’s chapter on evolutionary psychology and family violence.) Chap. 3 by McMillan and Shroeder critically considers the gender paradigm of male perpetrators and female victims within the context of intimate partner violence by also considering male-identified victims, gender and sexually diverse individuals, and violence within LGBTQ2+ relationships. Violence does not occur only in traditional nuclear heterosexual families, but also in lesbian and gay families. In Chap. 4, Waldner shows that although some basic data collection on the prevalence of violence in lesbian and gay families has been collected with widely varying results, explanations for this phenomenon are not obvious and sometimes seemingly contradict theories derived primarily from violence in heterosexual families. Although intimate partner violence is one of the most common forms of family violence, it is not the only one. As Hue San Kuay, Othman, and Tiffin show in Chap. 5, Adolescent Perpetrators of Violence and Aggression towards Parents, a minority of children and adolescents are violent to their parents. Although the functions of such aggression and violence are varied and include simple acquisitive-operant aggression, sometimes there appears to be a coercive process that is similar to that which sometimes occurs between adult partners. That is, some children and adolescents are aggressive, perhaps infrequently, but in the context of ongoing indirect and direct threats and coercion toward their parents. Additionally, as Karen Roberto demonstrates, senior family members may be both victims and perpetrators of aggression and violence within the family. The most commonly recognized form of violence is elder abuse by other family members which can take on many forms, from misuse and theft of personal money and possessions, abuse of guardianship, and verbal and physical abuse of the senior family member by their spouses, adult children, other family members, and in-home staff. Less frequently recognized is the problem of the senior family member as perpetrator of aggression and violence.

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Why does this family violence occur? What causes it? In Chap. 7, Angela J. Hattery, Katherine Kafonek, Allison Monterrosa, Emma Freetly Porter, and Earl Smith review the very wide range of theories that have been offered to explain this disturbing phenomenon. Reflecting the myriad of disciplines, perspectives, and political agendas of all kinds in the field of violence and aggression, there are many attempts to answer such difficult questions. This chapter reviews a sample of the more commonly cited approaches to explain violence and aggression, including feminist theories, criminology theories, Black feminist criminology, and psychological theories. These different theories are important as they often frame questions related to prevention and treatment. In Chap. 8, Stover and Shafai review prevention and treatment for children and adolescents exposed to family violence. Noting the variety of degrees of exposure to family violence and the wide range of mediating factors, such as parental attachment, they conclude that treatments should be individualized and matched to the needs of the child. Two long-standing approaches to prevention of family violence are behavioral and attachment approaches. Thus, in Chap. 9, Whitaker, Gurbani, and Rao address approaches to prevent or treat child maltreatment and intimate partner violence within the family focusing on these two main approaches  – parent skills training and attachment-based interventions to enhance parental sensitivity and responsivity to the child. The authors concluded that well-researched behavioral parent skills training programs such as Safe Care, Triple P, and Parent-­Child Interaction Therapy are quite effective in reducing child maltreatment, but that data are lacking for other approaches and interventions – both cognitive behavior therapy and feminist theory-based interventions – for intimate partner violence. Of course, it is not only therapists who are involved in prevention and treatment of violence but also many other social agencies. Thus, Chap. 10 by Walton and Hendry addresses actions by the police which may be effective and their application in practice and social policy within the context of New Zealand. Police can be involved in prevention of family violence in many ways, and Medina and Myhill’s chapter reviews the role of police in risk assessment and translating risk assessment in predicting effective practice in so-called risk-led policing using methods such as machine learning. In Chap. 12, James McGuire expands the focus on the prevention and treatment of family violence to consider the ways in which the police and courts act together in this field. In Chap. 13 by Morris and Humphreys, the authors consider infants, children, and adolescents as victims of family violence and illustrate the application of evidence-informed treatment in the context of Australia. An important but often neglected aspect of family violence is violence within military families who often have special challenges. In Chap. 13, Joel Milner, Julie Crouch, Joe Ammar, Wendy J. Travis, and Valerie A. Stander provide a comprehensive review of child maltreatment and domestic abuse within the US military. This chapter includes a comprehensive review of research on military family violence and adoption of evidence-based practices. One of the new and promising forms of therapy that many find intriguing is mindfulness. Although often applied to individual clients and staff in residential services, Chap. 15 by Nirbhay Singh, Giulio Lancioni, Rebecca Cheung, Oleg Medvedev, Yoon-Suk Hwang, and Rachel Myers reviews the family-focused

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application of mindfulness in which multiple family members learn mindfulness skills to promote peaceful and respectful interaction and reduce aggression and violence. These authors present a very nice, data-based case study of this approach. One important gatekeeper to services for family violence is healthcare staff and services. Caroline A. Fisher, Catherine Rushan, Riley Ngwenya, and Toni D. Withiel review what we know about the preparedness of health service staff, what physicians know, what the self-reported training needs are, and how effective current training practices are. There is much potential here and much left to do both in research and practice. An interesting and challenging chapter comes from Perry and Daly on the evolution of family violence. Chapter 17 frames the problem of family violence as one that has evolved biologically. The function of predominantly male on female violence is framed as one in which male proprietariness controls female infidelity and desertion. In this approach, self-report data on violence is de-emphasized as it seems to be unreliable and potentially inaccurate; rather, data on all forms of homicide within the family are preferred because they are more likely to be accurate, complete, and perhaps a meaningful index of other forms of violence. In this perspective, family violence is a biologically evolved behavior that includes relatively non-dangerous behavior such as parent-offspring conflicts over resources during child development, and lethal behavior such as siblicide and infanticide. The claim is that this approach explains some important family violence phenomena, namely the “Cinderella effect,” that is children who are not biologically related to their caretakers, such as step-parents, are at greatest risk of homicide especially from genetically unrelated male family members. The authors go on to consider implications for practice. Another interesting approach to violence which has been applied to family violence is restorative justice. It contains a very wide range of approaches that address many different aspects of violence. In Chap. 18, Theo Gavrilides presents restorative justice practices as those which involve rebalancing unequal power within the family which is an alternative to traditional criminal and civil responses to family violence. Finally, in Chap. 19, Barbara Blundell, Amy Warren, Marie Beaulieu, Kevin St-Martin, Vicki Ammundsen, Rebecca Waters, and Donna Chung consider the issue of how neglect and abuse in the lives of senior family members is represented and its policy implications in the context of services in New Zealand and Canada. I want to express my thanks to all the authors, who are internationally recognized experts in this field. They have produced high-quality chapters reflecting their years of careful scholarships and rich practice aimed at building more peaceful, respectful, and safer families. Queens, NY, USA

Peter Sturmey

Reference Steinmetz, S. K., & Straus, M. A. (1973). The family as cradle of violence. Society, 10, 50–56. https://doi.org/10.1007/BF02695281

Contents

Part I Fundamental Issues 1

 hat Is a Family? Issues in Defining Family����������������������������������������    3 W Barbara H. Settles

2

Definitions and Measurement of Family Violence and Aggression: Spotlight on Intimate Partner Violence ��������������������   31 Meredith E. Bagwell-Gray, Jill T. Messing, Ijeoma Nwabuzor Ogbonnaya, and Megan L. Brown

3

Gender Issues in Intimate Partner and Family Violence Research����������������������������������������������������������������������������������������������������   63 Iris F. McMillan, Grace E. Schroeder, Jan T. Mooney, and Jennifer Langhinrichsen-Rohling

4

 ay and Lesbian Families and Violence������������������������������������������������   83 G Lisa K. Waldner

5

Adolescent Perpetrators of Violence and Aggression Towards Parents��������������������������������������������������������������������������������������  105 Hue San Kuay, Azizah Othman, and Paul Alexander Tiffin

6

Older Family Members: Victims and Perpetrators of Elder Abuse and Violence����������������������������������������������������������������������������������  131 Karen A. Roberto

Part II Prevention and Intervention 7

Theories of Family Violence: Implications for Prevention and Treatment������������������������������������������������������������������������������������������  155 Angela J. Hattery, Katherine Kafonek, Allison Monterrosa, Emma Freetly Porter, and Earl Smith

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Contents

8

Individual Prevention and Intervention for Children Exposed to Intimate Partner Violence and Those Who Have Caused Harm����������������������������������������������������������������������������������  177 Carla Smith Stover and Anahita Shafai

9

I nterventions to Prevent Violence in the Family ����������������������������������  201 Daniel J. Whitaker, Arshya Gurbani, and Nikita Rao

10 P  olice and Court Interventions for Family Violence: Evidence-Based Practices������������������������������������������������������������������������  227 Darren Walton and Ross Hendy 11 P  olice and Intimate Partner Violence Risk Assessment: Searching for Evidence-Based Effective Responses������������������������������  253 Juanjo Medina and Andy Myhill 12 P  olice and Court Interventions for Family Violence����������������������������  277 James McGuire 13 W  hat About the Child? Bringing Children to the Fore in Australia’s National Domestic and Family Violence Agenda����������  307 Anita Morris and Cathy Humphreys 14 F  amily Violence in U.S. Military Families ��������������������������������������������  331 Joel S. Milner, Julie L. Crouch, Joe Ammar, Wendy J. Travis, and Valerie A. Stander 15 M  indfulness and Family Aggression and Violence��������������������������������  355 Nirbhay N. Singh, Giulio E. Lancioni, Rebecca Y. M. Cheung, Oleg N. Medvedev, Yoon-Suk Hwang, and Rachel E. Myers 16 F  amily Violence Professional Training Needs, Assessment, and Intervention in Healthcare Settings������������������������������������������������  375 Caroline A. Fisher, Catherine Rushan, Riley Ngwenya, and Toni D. Withiel 17 E  volutionary Psychology and Family Violence ������������������������������������  401 Gretchen Perry and Martin Daly 18 D  omestic Violence and Power Abuse Within the Family: The Restorative Justice Approach����������������������������������������������������������  421 Theo Gavrielides 19 N  ational Policies on Family Violence and Older People: How Is Elder Abuse Represented in Policy?������������������������������������������  441 Barbara Blundell, Amy Warren, Marie Beaulieu, Kevin St-Martin, Vicki Ammundsen, Rebecca Waters, and Donna Chung Index������������������������������������������������������������������������������������������������������������������  463

About the Editor

Peter  Sturmey  is a professor of psychology and The Graduate Center and the Department of Psychology, City University of New York. He specializes in applied behavior analysis in neurodevelopmental disorders, behavioral approaches to clinical psychology, and violence and aggression. His research has focused on staff and parent training. He has published over 30 authored and edited volumes, over 200 journal articles, and over 80 book chapters and is the series editor for Springer’s Advances in Prevention and Treatment of Violence and Aggression.

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About the Authors

Joe Ammar  is the coordinator of the Military Studies Program at the Center for the Study of Family Violence and Sexual Assault at Northern Illinois University. He has special expertise in research design and quantitative data analyses. He has been a co-investigator on several United States Air Force research contracts. Specifically, he has assisted in research related to assessing the risk of intimate partner physical abuse in military populations and in the evaluation of an enhanced home visitation program designed to reduce child maltreatment and intimate partner violence in United States Air Force families. Vicki Ammundsen  is the director of Vicki Ammundsen Trust Law and a Notary Public. She advises on all areas of trust and estate law and practice. She is the author of a number of texts including Taxation of Trusts, Trustee Liability, The Trustee’s Handbook, The Residential Care Subsidies Handbook, and A Practical Guide to Legal Issues for Older People. She is a highly regarded conference and webinar presenter and the creator of the blog, “Matters of Trust.” Vicki is actively involved in the creation and management of client trusts. Vicki believes that trusts play an essential role in modern family and business management. However, a lack of understanding of effective and correct trust management means that trusts are largely misunderstood and subject to abuse. Meredith  E.  Bagwell-Gray  is a trauma-informed sexual health interventionist. Her research promotes women’s health and safety in the context of gender-based violence. She brings an intersectional framework to her scholarship and uses community-engaged, critical, and feminist methodologies. Her research, which centers on the experiences of adult survivors of intimate partner violence in the United States, is informed by her social work practice as a survivor advocate and therapist. Dr. Bagwell-Gray serves as an assistant professor in Social Welfare at the University of Kansas. Marie Beaulieu  is a full professor at the School of Social Work of the University of Sherbrooke and a researcher at the Research Centre on Aging (Integrated to the xv

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Public Health and Social Services of Québec). She is a fellow of the Royal Society of Canada and has been the research chair on Mistreatment of Older Adults since November 2010. Since July 2017, she has co-directed a World Health Organization Collaborative Centre at the Research Centre on Aging specialized on age-friendly communities and countering mistreatment. The principal focus of her 30-year-plus career has been countering the mistreatment of older adults (and related issues such as criminal victimization, insecurity, bullying), promoting a wellness care approach, and ethics. She is involved in several national and international associations and networks and is a board member of the International Network for Prevention of Elder Abuse. Barbara  Blundell  is a senior lecturer in Social Work, in the School of Allied Health at Curtin University. She is a member of the enAble Institute’s Dementia and Ageing domain and a fellow of the Australian Association of Gerontology. Research interests include aging and disability issues, caregiving, elder abuse, advocacy, and service and social policy responses to these issues. She has conducted a number of research projects in these areas over the past 20 years, in partnership with both government and non-government organizations in Western Australia, Queensland, and across Australia. Barbara began her social work career in older person’s advocacy, and her PhD was entitled Contextualising Human Rights: Residents’ Rights in Nursing Homes and Hostels. Her project, Review of the Prevalence and Characteristics of Elder Abuse in Queensland, was awarded the Adam Sutton Crime Prevention Award (2020) from the Australian and New Zealand Society of Criminology. Megan L. Brown  is a senior counselor at Arizona State University. Her research focuses on the use of information communication technologies within intimate relationships, especially technology-­based abuse. Applied projects include adapting technology to support victims of domestic violence. She has published several scholarly articles about the impacts of online harassment, the influence of digital media on young adults’ intimate relationships, and adapting technology for survivors. She was co-editor for the anthology, Micro-celebrity Around the Globe (2018), a series of case studies examining influencers across cultural contexts. Rebecca Y. M. Cheung  is an associate professor at the School of Psychology and Clinical Language Sciences at the University of Reading, UK. Her research focuses on mental health and well-being across developmental periods. Her recent work highlights the role of mindfulness in family functioning, parents’ mental health, and children’s behavioral adjustment. Donna  Chung  is a professor of Social Work and Social Policy. She has been involved in social work education and social research for over 25 years undertaking various teaching, research, and management roles within higher education. Donna previously held the positions of Winthrop Professor of Social Work and Social Policy at the University of Western Australia, Associate Professor of Social Work

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and the Director of the Centre for the Study of Safety and Wellbeing at the University of Warwick, and Senior Lecturer at the University of South Australia. Her research interests are primarily the areas of male violence against women, homelessness, gender and sexuality, and social policy. Donna has worked on various research projects in these areas and provides advice and consultancy to governments on policies and programs in these areas. Donna is a member of a number of organizations and committees working to end male violence against women. Julie L. Crouch  is the director of the Center for the Study of Family Violence and Sexual Assault at Northern Illinois University. Dr. Crouch has over 20  years of experience in conducting research investigating various aspects of family violence. Areas of expertise include assessment of risk for child physical abuse perpetration, assessment of risk of injury/death in the context of domestic violence, and assessment of functioning in individuals exposed to traumatic events. Dr. Crouch has provided consultation to a variety of types of service providers, including child abuse prevention agencies, domestic violence intervention programs, and trauma-informed treatment providers. Her research has been supported by the Centers for Disease Control and Prevention, National Institute of Child Health and Human Development, Office of Violence Against Women, Illinois Department of Children and Family Services, the US Air Force, and various local/regional partners. Martin Daly  is a professor emeritus of Psychology, Neuroscience and Behaviour at McMaster University. After completing his PhD in psychology at the University of Toronto in 1971, Daly studied the behavioral ecology of desert rodents for many years, but by 1990, a secondary line of research on human violence, in collaboration with the late Margo Wilson, had become his primary focus. His recent research, in collaboration with Gretchen Perry, mainly concerns determinants of grandparental investment. Daly is a past-president of the Human Behavior and Evolution Society and a recipient of that society’s Lifetime Achievement Award. He is an author of over 100 refereed journal articles, many book chapters, 4 books coauthored with Wilson, and a 2016 monograph, Killing the Competition: Economic Inequality and Homicide. In 1998, Daly was elected a fellow of the Royal Society of Canada. Caroline A. Fisher  leads the Psychology and Family Safety Teams at the Royal Melbourne Hospital and is also the chief neuropsychologist at The Melbourne Clinic. She is a clinician researcher with 17 years experience as a neuropsychologist and over 40 peer-reviewed research publications in the areas of neuropsychology, clinical psychology, and family violence. Theo Gavrielides  is a legal philosopher and a world-known restorative justice and human rights expert. He is the founder and director of the Restorative Justice for All (RJ4All) International Institute, which aims to advance community cohesion and redistribute power through education and the values of restorative justice. He is also the founder and editor-in-chief of RJ4All Publications, which is the publishing arm of RJ4All. In 2021, Professor Gavrielides received The Liberty of the Old

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Metropolitan Borough of Bermondsey Award as part of the Southwark Civic Awards 2020 for his contribution to the community during difficult times. He is the editorin-chief of the peer-reviewed journals International Journal of Human Rights in Healthcare, Youth Voice Journal, and The Internet Journal of Restorative Justice. Professor Gavrielides has published extensively on social justice matters and human rights. His 2007 monograph Restorative Justice Theory and Practice was published by the European Institute for Crime Prevention and Control affiliated with the United Nations and his 2021 monograph Power, Race & Restoration: The Dialogue We Never Had by Routledge. Arshya  Gurbani  is a PhD student in epidemiology at Georgia State University and a graduate research assistant with the National SafeCare Training and Research Center. She is a health communication specialist whose research interests lie at the intersection of chronic disease prevention, health equity, and statistical modeling. Angela J. Hattery  is Professor of Women and Gender Studies and co-director of the Center for the Study and Prevention of Gender-Based Violence at the University of Delaware. She is the author of 12 books, including Policing Black Bodies: How Black Lives Are Surveilled and How to Work for Change (2021), Gender, Power and Violence: Responding to Intimate Partner Violence in Society Today (2019) as well as dozens of book chapters and peer-reviewed articles. Her most recent book (2023) is entitled Way Down in the Hole: Race, Intimacy and the Reproduction of Racial Ideologies in Solitary Confinement explores the ways in which racial antagonisms are exacerbated by the particular structures of solitary confinement. She serves as a consultant to agencies that seek to combat violence against women; testifies as an expert witness in domestic violence cases; and regularly comments in the local, regional, and national news media on issues related to gender-based violence and the criminal legal system. At the University of Delaware, she teaches courses on race and gender inequality, families, and methods. Ross  Hendy  is a lecturer in criminology at Monash University, Melbourne, Australia. His research interests include police use of force, police-citizen interaction, and the effectiveness of police crime and harm reduction interventions. Before academia, he had a 13-year career with New Zealand Police, holding a variety of front-line policing roles, custody supervision (as a custody sergeant), and later a senior practitioner researcher with the research and evaluation unit and the EvidenceBased Policing Centre. He is a fellow of the Higher Education Academy, a member of the Royal Society of New Zealand, and the American, Australian, New Zealand, British, and European societies of criminology. Cathy Humphreys  is Professor of Social Work at the University of Melbourne. She is a founding member of the Melbourne Research Alliance to End Violence Against Women and their Children and a chief investigator on the Safer Families National Health and Medical Research Council Centre for Research Excellence. Her research focuses on domestic and family violence and child abuse. She has a

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long-term interest in ensuring that the voices and experiences of children are visible, and they are acknowledged as primary victims of domestic and family. Yoon-Suk Hwang  is a researcher and practitioner in mindfulness, special needs, behavioral support, and inclusive education. Her research interests include the applications of mindfulness for empowering individuals with social, emotional, behavioral, and learning difficulties, student voices and engagement; special needs and family support; bullying and autism spectrum; and arts-­based inquiry. Katherine Kafonek  is an assistant professor of Criminology at California State University, Fresno. Kate’s work focuses on gender-based violence victimization, sex education and prevention programming, and equity-minded pedagogy. She teaches courses on victimology and intersectional criminology. Recent research has been published in Violence Against Women, Feminist Criminology, and Journal of School Violence. Hue  San  Kuay  is a psychology lecturer at the Department of Psychiatry in the School of Medical Sciences at Universiti Sains Malaysia. She was an honorary psychology assistant of the Forensic Child and Adolescent Mental Health Service for Tees, Esk, and Wear Valleys region, UK. During her time with the NHS, she worked closely with young people with behavioral problems, especially those who perpetrated aggression toward family members and their parents. Hue San’s research interests primarily focus on family violence, which was the area of specialization of her doctoral research. She is a co-author of a recently published book on Child to Parent Aggression and Violence: A Guidebook for Parents and Practitioners. Jennifer  Langhinrichsen-Rohling  is a professor in the Department of Psycho­ logical Science at the University of North Carolina at Charlotte. She is core faculty in the Clinical Health concentration of the Health Psychology PhD program and a licensed clinical psychologist in North Carolina. She is an established scholar with over 200 peer-reviewed publications and book chapters. Her research focuses on individual, couple, family, and system-level factors associated with prevention and response to intimate partner violence, sexual assault, and self-harming behaviors. She has recently been working at the system level to promote trauma-informed care and prevent and repair institutional betrayal. Across her career, she has directed the Gulf Coast Behavioral Health and Resiliency Center and the Youth Violence Prevention Program at the University of South Alabama. Currently, she routinely consults with integrated healthcare settings, women infants and children clinics, domestic violence batterer intervention programs, service providers, and community advocacy groups to enhance access to evidence-based services for underresourced populations. Most recently, she served as a section editor of the intimate partner violence component of the five-­volume Handbook of Interpersonal Violence and coeditor of the 2022 book, Sexual Assault Kits and Reforming the Response to Rape.

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About the Authors

James McGuire  is a clinical and forensic psychologist and Emeritus Professor of Forensic Clinical Psychology at the University of Liverpool. He is a member of the Ministry of Justice Correctional Services Accreditation and Advice Panel, and carries out psycho-legal assessments for hearings of the Mental Health Review Tribunal and the Parole Board in the United Kingdom. He initially worked as a practitioner in intellectual disability services and in a high-security hospital. He has conducted research in prisons, probation services, youth justice, secure mental health units, and addictions services on aspects of the effectiveness of rehabilitation with offenders and related topics, and has written or edited 16 books and over 150 other publications in these areas. He has been an invited speaker in the United Kingdom and 21 other countries and has engaged in a range of consultative work with criminal justice agencies in several parts of the world. Iris  F.  McMillan  is a doctoral candidate in clinical concentration of the Health Psychology doctoral Program at the University of North Carolina at Charlotte. Previously, she completed her undergraduate and graduate-level training in Psychology at the Alpen-Adria University in Klagenfurt, Austria. Her research focuses on the use of quantitative methods to advance diversity, equity, and inclusion efforts in dating violence research as well as dating violence prevention efforts. Specific research and clinical interests include dating violence within the LGBTQIA+ community as well as the promotion of relational and gender health, particularly during developmental transitions. Juanjo  Medina  is a Talentia senior distinguished researcher affiliated to the Department of Criminal Law and Crime Sciences at the University of Seville. Previously, he held positions in the US and the UK. He has been awarded honorary appointments with the University of Manchester, as a research professor, and the Institute for Metropolitan and Regional Studies of Barcelona. He was the president of the Spanish Society of Criminology from 2016 to 2020. He is a quantitative social scientist interested in the study of intimate partner and gang violence, spatiotemporal distribution of crime, policing and crime prevention, and data science applications in criminal justice. Oleg N. Medvedev  is a professor at the University of Waikato, New Zealand, and editor of the journal Mindfulness. He is actively involved in mindfulness and healthrelated research covering mindfulness-based interventions, well-being, healthrelated quality of life, affective disorders, and healthy mental aging. He is an author of many peer-reviewed journal articles and book chapters, and coauthor of the book Mindfulness-Based Intervention Research: Characteristics, Approaches, and Developments and the Handbook of Assessment in Mindfulness Research. Jill T. Messing  is a professor in the School of Social Work and the director of the Office of Gender-Based Violence at Arizona State University. Dr. Messing specializes in the development and testing of intimate partner violence risk assessments. As a social worker, she is particularly interested in the use of risk assessment in

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collaborative, innovative interventions, and as a strategy for reducing intimate partner violence and homicide. Joel  S.  Milner  is Professor Emeritus of Clinical Psychology, Distinguished Research Professor, and Founder/Director Emeritus of the Center for the Study of Family Violence and Sexual Assault at Northern Illinois University. Dr. Milner has received more than 100 grants and contracts from private, state, and federal agencies, including the National Institute of Mental Health, National Science Foundation, Center for Disease Control and Prevention, National Conference on Child Abuse and Neglect, the Navy, the Air Force, and the Department of Defense. Dr. Milner is the author or co-author of more than 200 scholarly publications, the majority of which describe empirical studies in the areas of child maltreatment, intimate partner violence, and sexual assault. His military-related work has included assisting in the development and validation of navy, gender-­specific sexual assault education/prevention programs; studying the impact of combated-related deployment on child maltreatment and spouse abuse in Air Force families; and developing/validating the military Intimate Partner Physical Injury: Risk Assessment Tool that is used at military bases worldwide. Allison  Monterrosa  is an assistant professor of Sociology, Criminology, and Justice Studies at California State University San Marcos. Her areas of specialization are critical criminology and socio-legal studies, medical sociology, critical race, and gender theories. Her research topics include gender-based violence, racialized state violence, the health implications of racism, and the intersections of the carceral state. Her work has been published in the Journal of Interpersonal Violence, Feminist Criminology, Race and Justice, Violence Against Women, and Rutgers Criminal Law and Justice Books. Jan T. Mooney  is a doctoral candidate in the clinical concentration of the Health Psychology Doctoral Program at the University of North Carolina at Charlotte. Previously, she completed an undergraduate degree in Psychology at the University of California at Berkeley and a master’s degree in Marriage and Family Therapy at Pfeiffer University. Broadly, she is interested in interoceptive awareness in the context of complex body experiences (e.g., trauma, chronic illness, pain), behavioral, affective, and cognitive correlates, and relevance of these relationships to health and well-being, with a particular emphasis on developmental transitions (e.g., adolescence, pregnancy, postpartum) and the contribution of multiple and interacting systemic influences (e.g., racism, sexism, healthcare, law/policy). Anita Morris  is the Statewide Family Violence Principal Practitioner at Department of Families, Fairness, and Housing in Victoria, Australia. Through an evidencebased practice lens, she provides advice to the government on the implementation of key recommendations of the 2016 Royal Commission into Family Violence and leads reforms in family violence training for the child protection workforce. She has a background in social work across health, education, and the community sector and

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completed her PhD on children’s experiences of family violence at the University of Melbourne in 2015. Her research interests include ethical approaches to researching children experiencing family violence, implementing trauma-informed practice frameworks, and the role of technology when children are experiencing family violence. Rachel E. Myers  is a full professor and the associate director of Undergraduate Programs in the Wellstar School of Nursing at Kennesaw State University, Kennesaw, Georgia. Her research interests include mindfulness-based interventions, health and wellness promotion, disease prevention, diabetes, and nursing education. She is a qualified mindfulness-based stress reduction teacher through the Center for Mindfulness, UMass Medical School. She is an author of many peer-­reviewed journal articles and book chapters related to mindfulness-based intervention research. Andy  Myhill  is an evidence and evaluation advisor at the College of Policing, UK. He has over 20 years’ experience of research on crime and policing. He has published both government reports and academic journal papers on police legitimacy and procedural justice, the measurement of domestic abuse, and police response to domestic abuse. He has led programs for the evaluation of police training and risk assessment for domestic abuse. Giulio  E.  Lancioni  is Professor in the Department of Neuroscience and Sense Organs, University of Bari, and Director of the Lega F.  D’Oro Research Center, Osimo, Italy. His research interests include development and assessment of assistive technologies, evaluation of alternative communication and choice strategies, and training of social and occupational skills for persons with severe, profound, and multiple disabilities due to congenital encephalopathy, neurodegenerative diseases, or acquired brain injury. Riley Ngwenya  is a senior clinician and trainer in the Family Safety Team at the Royal Melbourne Hospital. In this role, she supports Royal Melbourne Staff as a part of a team to strengthen the hospital’s response to family violence. Riley has been a family violence specialist for over six years including her work at the 24 hour state Family Violence Services in Victoria as a senior practitioner. Ijeoma Nwabuzor Ogbonnaya  is an assistant professor of Social Work at Arizona State University. She investigates how sociocultural factors (e.g., race/ethnicity, immigrant status, acculturation) influence intimate partner violence survivors’ service outcomes. She also studies how intimate partner violence uniquely impacts survivors’ physical, emotional, and behavioral health. Dr. Ogbonnaya focuses on populations most vulnerable to intimate partner violence, including child welfare system-involved families and people living with HIV. Her scholarship aims to build knowledge to inform the design and testing of innovative interventions to reduce the adverse health, social, and economic consequences of IPV.

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Azizah Othman  is Associate Professor in Clinical Psychology at Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia. She is a program developer and co-­ordinator for the Integrated Psychology Program Master and Doctorate in Psychology (Clinical Psychology) jointly offered by Universiti Sains Malaysia and Universiti Pendidikan Sultan Idris. She teaches psychology and supervises students at various levels in medical and health departments. She is a consultant clinical psychologist at Universiti Sains Malaysia’s Executive Polyclinic and provides psychological assessment and psychotherapy at Paediatrics and Psychology Clinic Hospital Universiti Sains Malaysia. Her research interest includes psychological development and problems in children and adolescents especially with chronic illness such as cancer, as well as cognitive behavior therapy and techniques including mindfulness and their effectiveness on children, young adults, and parents of children with challenging medical conditions. Gretchen  Perry  is an associate professor in the Anthropology Program at the University of Canterbury, New Zealand. Her research focuses on cooperation and conflict in the family, including non-parental caregiving of children, fosterage and adoption, and family homicide. She uses qualitative and quantitative methods from epidemiology and ethnography, as well as structured interviews. She continues to be interested in child protection research in Canada, as well as the impact of immigration on childcare and subsequent child development. She comes to this work as a cultural anthropologist and registered social worker with a 25-year career in social services work with vulnerable individuals and families in Canada. This has allowed her to work across disciplines, using a culturally comparative approach. Her most recent focus is on family homicide in New Zealand. Emma  Freetly  Porter  is a counseling psychologist, currently working at NYC Health and Hospitals, primarily with individuals who are incarcerated. She is also an adjunct lecturer at City College of New York. She focused her research on psychotherapy processes and outcomes, including multiculturalism, cultural humility, and flourishing in psychotherapy. Nikita  Rao  is a doctoral candidate in Health Services and Policy Research at Georgia State University and a graduate research assistant with the National SafeCare Training and Research Center. Her research concerns migration, race, and housing. Karen A. Roberto  is a university distinguished professor and senior fellow at the Center for Gerontology at Virginia Tech. Her research focuses on health and social support in late life and includes studies of the health of rural older women, dementia, family caregiving, and elder abuse. Her elder abuse research has examined early childhood mistreatment and late-life relationships and elder abuse and the opioid epidemic and focuses on several types of abuse including sexual abuse, intimate partner violence, polyvictimization, and financial exploitation. She has over 200 scholarly articles and book chapters and is editor/author of 15 books. Dr. Roberto is

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a fellow of the American Psychological Association, the Gerontological Society of America, and the National Council on Family Relations. She is the recipient of the Gerontological Society of America Behavioral and Social Sciences Distinguished Mentorship Award and the Australian Association for Gerontology. Catherine Rushan  is a research assistant and member of the Family Safety Team at the Royal Melbourne Hospital. She holds a Bachelor of Science degree from the University of Melbourne and a Graduate Diploma in Psychology (Advanced) from Deakin University, and is currently completing her Master of Educational Psychology at the University of Melbourne. Grace E. Schroeder  received her undergraduate degree in Psychology from the University of North Carolina at Charlotte in 2022. She is now working as a postbaccalaureate research assistant in Dr. Langhinrichsen-Rohling’s THRIVE LAB at the University of North Carolina at Charlotte. Grace is passionate about conducting violence research concerning family structures, healthcare equity, and underserved populations. Grace plans to complete graduate education which will focus on the impact of social determinants of health on functioning post-violence. Barbara H. Settles  is Professor of Human Development and Family Sciences at the University of Delaware. Among the recognitions, she received are the University of Delaware Women’s Caucus Torch Award for Lifetime Work in Women’s Equity; Fellow of the National Council on Family Relations; the Jan Trost Award for Outstanding Contributions to Comparative Family Studies; Lifetime member Groves Conference on Marriage and Family; American Home Economics Association; and Massachusetts Avenue Award, for an invited paper, Changing Social Values. Her interests include gender, family and life course relationships, family life education across the life course, policy, and equity in higher education. Anahita  Shafai  is a doctoral candidate in Clinical Psychology at the Oxford Institute of Clinical Psychology Training and Research, Oxford University. Anahita completed a research masters in Developmental Neuroscience and Psychopathology jointly at University College London and Yale University, writing a thesis investigating the impacts of intimate partner violence on child outcomes and co-authoring a publication on the assessment of intimate partner violence using standardized measures. This followed her BSc in Psychology at Queen Mary University where she received an Outstanding Academic Achievement Award for her dissertation investigating the links between religiosity, culture, and prosocial attitudes and behavior. Anahita has also worked in the UK as an assistant psychologist in the NHS and as a policy advisor in the Civil Service. Nirbhay  N.  Singh  is Clinical Professor of Psychiatry and Health Behavior at Augusta University, Georgia, USA.  His research interests include mindfulness, behavioral and psychopharmacological treatments of individuals with disabilities, and assistive technology for supporting individuals with diverse disabilities. He has

About the Authors

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published extensively in these areas. His most recent books include Mindfulness in the Classroom (with Felver) and Mindfulness-Based Interventions with Children and Adolescents (with Singh Joy). Earl  Smith  is Professor of Women and Gender Studies at the University of Delaware and Emeritus Distinguished Professor of American Ethnic Studies and Sociology at Wake Forest University. Dr. Smith earned his PhD at the University of Connecticut. His teaching and research focus on the sociology of sport, social stratification, and the intersection of race and the criminal justice system. He is the author of 12 books, including his most recent books, Policing Black Bodies, second ed. (2021), Gender, Power and Violence (2019), and Way Down in the Hole: Race, Intimacy, and the Reproduction of Racial Ideologies in Solitary Confinement (2021). Kevin  St-Martin  is a master’s student in Social Work at the University of Sherbrooke and the co-coordinator of the Research Chair on Mistreatment of Older Adults since April 2022. He obtained a Mitacs Acceleration graduate scholarship with the Jasmin Roy Sophie Desmarais Foundation in 2020 for the ongoing production of his master’s thesis on the use of virtual reality as a tool to raise awareness of mistreatment, bullying, and agism toward older adults. Since he first joined the Research Chair on Mistreatment of Older Adults as a research assistant in 2018, he has participated in various projects including, leading awareness-raising activities, writing research reports, and leading webinars. He has also contributed to the writing of multiple publications, including book chapters, governmental reports, and scientific papers. His principal research interest includes the mistreatment of older adults, bullying, and the use of technology in social work intervention. Valerie A. Stander  is a research psychologist at the Naval Health Research Center studying the health and well-being of military personnel and their families. She is currently the principal investigator of the Millennium Cohort Family Study, a 21-year longitudinal program of research documenting the impact of military life stress on family relationships. Dr. Stander is also principal investigator in a research collaboration with Abt Associates evaluating the efficacy of a pilot implementation of HealthySteps supported by the Defense Health Agency and the Office of Military Community and Family Policy. Her specific areas of interest include risk factors for interpersonal aggression, including patterns of family violence. Dr. Stander earned her PhD in Family Studies at Purdue University and continues collaborating with researchers at the Purdue Military Family Research Institute on the Operation Military Experience study funded by the National Institutes of Health and the Military Operational Medicine Research Program. Carla Smith Stover  is a licensed clinical psychologist and associate professor at the Yale Child Study Center. Her clinical work has included acute/peri-traumatic responses to families impacted by violence and long-term evidence-based treatments including trauma-focused cognitive behavioral therapy and child parent psychotherapy. Dr. Stover was awarded a Career Award from the National Institute of

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Drug Abuse to develop and evaluate an intervention for fathers with co-occurring substance misuse and intimate partner violence that targets their roles as fathers. She developed Fathers for Change and is conducting outpatient, residential treatment, and community implementation studies on the effectiveness of the intervention. She is also co-investigator on an NIH-funded study of a co-parenting intervention for unmarried, low-income African American parents having their first child. She chairs the Early Stress and Adversity Consortium at the Yale School of Medicine. She has presented trainings nationally and internationally on the topics of family conflict, healthy relationships, stress management, family violence, engaging and treating fathers, and interventions for childhood trauma. She has published widely on the topics of childhood trauma, intimate partner violence, and substance misuse. Paul Alexander Tiffin  is a quantitative methodologist, with an interest in psychological measurement and prediction (“psychometric epidemiology”). This involves using psychological measurement to quantify individual differences in people and then using data modeling to make predictions about future outcomes of interest. He has extensively applied this approach to both health services and clinical workforce issues. Wendy  J.  Travis  is a retired Air Force Lieutenant Colonel, Licensed Clinical Social Worker, and Research Associate with the Center for the Study of Family Violence and Sexual Assault at Northern Illinois University. She has over 25 years of military and clinical experience and 15 years of research experience in the areas of family violence treatment and prevention, mental health, substance abuse, and sexual assault. She has a specific interest in the translation of evidence-based and evidence-informed findings into mental health, nursing, and educational practice. While serving in the Air Force, she oversaw a $2  M research portfolio aimed to improve the clinical and preventative services delivered to military members and their families. She taught Behavioral Sciences to cadets at the United States Air Force Academy and was the principal investigator for a study that tested the implementation of a sexual assault prevention program for cadets. Lisa  K.  Waldner  is Professor of Sociology and Associate Vice Provost for Undergraduate Student Achievement at the University of St. Thomas in St. Paul, Minnesota. She has taught courses in statistics, research methods, and sexuality and is co-author of Power, Politics, and Society: An Introduction to Political Sociology published by Routledge. Her published work is primarily focused on intimate partner violence in same-sex relationships, graffiti as a form of political activism, and white power extremism. She has received several teaching awards including being named a John Ireland Professor (2015) and receiving the Undergraduate Research and Collaborative Scholarship Award for her work with students at the University of St. Thomas. She was co-editor of The Sociological Quarterly from 2012 to 2016 and is an editorial board member for the journal Violence and Victims.

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Darren Walton  is Director of Crow’s Nest Research. He is a specialist data scientist that uses administrative data, such as police data, to provide evaluations of government programs. Darren is an associate professor of Psychology at the University of Canterbury and has held previous roles in New Zealand Police and in public health across the portfolios of tobacco, gambling, alcohol, and drugs. Darren’s academic interests include the development and use of the New Zealand Crime Harm Index, the use of embedded analytics, and the use of technology-assisted data capture to improve police practice. Amy Warren  is a PhD candidate, Sessional Academic and Research Assistant in the School of Allied Health at Curtin University, Australia. She also works as a senior social worker at St John of God Hospital Subiaco in Perth, Western Australia. Amy began her research career as an honors student, exploring the barriers and facilitators to older women’s help-seeking for elder abuse (completed 2017), and went on to work as a research assistant, primarily working on projects in the areas of elder abuse, and domestic and family violence but has also worked on research projects in advocacy, hybrid teaching, and disability education for social work students. Amy is currently in her final year of a PhD exploring conceptualizations and responses to violence against women across the lifespan. Rebecca Waters  teaches and researches in the Curtin School of Allied Health at Curtin University is the Occupational Therapy Discipline Lead. Her PhD entitled Person-Centredness in Human Services: An Evidence-Based Conceptualisation to Inform Practice explores person-centered approaches and care and how these are operationalized in services. Rebecca has worked extensively in human services in Western Australia as an occupational therapist in residential and community-­based aged and dementia care services; residential and community-based disability services; complex case management in disability and mental health service delivery; and complex behavioral support for children in private practice. Rebecca also has significant experience in policy translation and operationalization in disability services. She has held leadership and management positions in Local Area Coordination at the Western Australia Disability Services Commission and has been responsible for managing teams of diverse staff and a multi-million-dollar budget at a grassroots level. Daniel J. Whitaker  is a distinguished university professor in the School of Public Health at Georgia State University. Whitaker co-directs the National SafeCare® Training and Research Center, which disseminates the evidenced-based parenting model, SafeCare, nationally and internationally. His research has focused on child maltreatment prevention, intimate partner violence prevention, and dissemination and implementation science. His work has been funded by the Center for Disease Control and Prevention, National Institutes of Health, Agency for Healthcare Research and Quality, Person-Centered Research Institute, Administration for Children and Families, the Doris Duke Charitable Foundation, and the Annie

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E.  Casey Foundation. Whitaker has published over 100 peer-reviewed papers, books, and chapters and is past editor-in-chief of Child Maltreatment. Toni D. Withiel  is an early career researcher and clinical neuropsychologist at the Royal Melbourne Hospital. She has published over 20 peer-reviewed articles in the area of neurorehabilitation and family violence and has presented her work both domestically and internationally.

Part I

Fundamental Issues

Chapter 1

What Is a Family? Issues in Defining Family Barbara H. Settles

Bringing a family perspective to intimate partner violence (IPV) requires some fresh theoretical ideas. Couple violence has become an important area of study in various disciplines and has become well recognized. However, sibling, parent, and intergenerational violence with elders have been somewhat isolated and not seen as a whole system. To move toward a family/household paradigm, would require including family relationships beyond the “victim” and the “perpetrator.” Through some discussion of terms and processes that could be helpful in better characterizing what goes on in friendship, partner, child, and elder abuse, we may come closer to developing a family view of violence and how the contexts of household and family interact. Conflict is a foundation for possible violent behavior as is argument itself. Challenges that families face in maintaining a home, employment, education, health and safety, entertainment, and long-term security provide many opportunities for disagreements on issues, planning, priorities, techniques, and responsibilities. For example, the literature on housework has shown more men actually doing more types of activities, but still finds women doing the planning, coordination, and seeing to the completion of tasks (Perry-Jenkins & Gerstel, 2020). Limiting money and resources are frequently part of spousal abuse by men. Today, parents are commonly encouraged to do “intensive” parenting that involves a lot of interaction and attention to details. “Harsh parenting” includes both harsh physical and emotional punishment. In spite of the repeated studies that show spanking as being associated with poor outcomes for children, there is not a willingness to confront it with parents. Elders may also be involved at a high level with their grandchildren and are often the emergency resource when problems occur. Recently, social services have become more willing to make grandparent placements for long-term care. Elders may need support and care, which puts them at risk B. H. Settles (*) Human Development and Family Science, University of Delaware, Newark, DE, USA e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 P. Sturmey (ed.), Violence in Families, Advances in Preventing and Treating Violence and Aggression, https://doi.org/10.1007/978-3-031-31549-7_1

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to abuse and neglect. The term exploitation is often used to indicate violence, abuse, and neglect. By not using similar language for personal violence in different dyads, the impact is lessened for the whole family and household. It is also reasonable to be clear about the impact of verbal assaults and various isolation and distancing strategies. Although rejection, distain, and other negative sanctions may not be overtly physical does not make them a wholesome alternative. It has been shown that institutional alternatives in the juvenile justice system, pull out school alternatives, mental health facilities, and individual treatment can harbor other violence and exploitation of the clients. Community level violence requires attention as that aspect is particularly fraught with discrimination in terms of race, poverty, gender, and lacks in public services. The vast private ownership and use of firearms has attracted some study and attempts at safety and control. In order to classify and serve households and families on violence issues, the various strands of the study of family, household, and community violence need to be brought together. There is a challenge to imagining what seems to happen. First, imagine deciding to choose someone who has already been violent as a partner. Second, imagine that couples living together could maintain recurrent incidents of violence seems at first glance unlikely. Recognizing family as a context for violence challenges our romantic vision of family life. Ongoing violence between and among persons is most likely to become a recurrent pattern where they share households and are seen as family members or share a common community. Understanding how such conflict and behavior can be built into relationships and become tolerated or the target of criticism requires recognizing the wide variety of daily living conditions and family interactions. The initial waves of scholarly and policy attention to intimate partner, parent–child, elder– caregiver, and disability care violence focused on the dyads involved and on changing policy and program outreach and support for victims. The role of household and family in supporting, perpetuating, ignoring, or seeking intervention has begun to be addressed. While much abuse and violence is hidden or sheltered in homes and institutions such as schools and recreation organizations, these issues can be addressed directly and consistently if they are recognized, and actions created and pursued. Seeing psychological abuse as a part of IPV that is prevalent, has received less attention that could improve responses (Gewirtz-Meydan & Finzi-Dottan, 2021). In this sense, aggression is meant to harm a person’s well-being, degrade or attack self-worth, and induce guilt. The purpose of this review is to explore how definitions and inclusion actions are family matters for those involved —the victims, their perpetrators, the other relatives and close connections, and the near and greater community. In addition, it is important to include those agencies and professionals who have responsibility in the area of interpersonal violence for creating awareness, interventions, evaluations, revisions of policy and legal framework that can make a difference must deal with the variety of living situations and people who participate in daily life together.

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5

1 Toward a Taxonomy of Families Family as a nexus for examining how violence is allowed or restrained and who is likely to be protected, exposed, or attacked continues to be central to both the debates and actions recommended and expressed. The diversity in families is more recognized today than at earlier times in our history or across the world (Cherlin, 2020; Furstenberg, 2020). Timmerman and Prikett (2022) built on this diversity both in family units and kinship configuration in these changes to a necessary refitting of legal concepts. They call attention to the growth of one-person households and issues of estrangement becoming common. Family is not the only situation in which violence occurs, but it is among the more stable settings where conflict leads to violence and repeated violence is expressed. Furstenberg (2020) reviewed family research and theory and noted little focus on kinship. Lots of data are gathered on households and are available but without clear definition of the family(ies) and others within the households. In addition, connections among households are not usually available. Families are the social arrangement to give its members “a sense of identity and shared belonging” (p. 365) and to maintain connections with other relatives. The US Census is a household survey that was initiated to help set up voting districts and has over the years expanded to provide local-, state-, and national-level data useful to government and private groups. Basically, the US Census data report on the family of residence. Kin relationships and friendships that take on the style of informal kin need to be examined more deeply into the purposes they serve in family events. Approaches to the utility of definitions of family stem from the need to have a common understanding of what families are being examined and identifying stability and change. These include lifestyle and life course transitions. Prevalence and durability, and family dynamics in such areas as intimacy, involvement, and conflict, guided an earlier project of family definitions (Settles, 1987). Six examples of definition included family as (1) ideological abstraction, (2) romantic image, (3) unit of treatment, (4) last resort, (5) process, and (6) networks. Among many ideas in that analysis, a concept that seems on point today is: “Involvement in close family interaction provides an opportunity not only for the expression of affection, but also for playing out negative emotions and actions” (Settles, 1987, p. 173). The development of a large literature on family violence and approaches to intervention and support that has occurred since this exploration provides many more theoretical ideas to address the variety of families who have violence and abuse issues. This approach was part of an interest in how and when families initiate change. To develop a taxonomy of families and violence, these categories suggest some aspects that might apply. The study of personal violence in the context of family and household has had to deal with denial, privacy issues, and the legal implications under different local legal codes. While it is possible to assume that these differences could be raised up to more generic abstraction that could bridge them as an ideological abstraction, it would not be easy. There is not a simple way to ask about the use of other ways of conflict

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mediation and outcomes that might provide a measure of alternative to violence that may be present in families. Romantic images do seem to be implicated in some close relationships where violence has been identified as common. Jealousy is often framed by those involved as an expression of love, not as controlling process. Even some violence may be described as representing positive concern. It could be that this line of defining violent interaction could be used to change perceptions. Family and household violence do raise issues of whether the behaviors might respond to some intervention or treatment. Both psychological and couple or family therapy could be made more accessible and public health outreach might increase the visibility and ease of connecting. Shelters are still needed and adolescents, especially adolescent boys, are not reliably helped. Members of families often turn to their family or household as a last resort when they have suffered on their own or are being accosted in public places or needing to be protected. For elders their own last resort may have run out and they need care. Illness and surgery also bring families back into their members’ lives. Using legal orders for protection is usually needed. Looking at process in families may highlight some of the difficulties due to violence and/or how violence is being supported. Breaking long-term patterns requires attention to the ways people interact and evaluate their situations. While this process may be linked to intervention or treatment, it may also respond to education or workshop programs. Networks can be quite complex, and individuals and couples may not understand the variety of ways that people are influenced by each other and through secondhand information. Medical and health services have been able to rally help and involvement in long-term care. The likelihood of finding more ways of looking at individuals, families, and communities is high, especially once a community is aware of needs and possible resources. These defining processes can be helpful in rallying assistance and support. The changes that have been made nationally and from state to state in recognizing new legal bases for recognition and access to marriage and parenting have had major impacts. The movement for marriage equality has also created interest in how these new families are relating to community life (Ocobock, 2018). Lesbian, gay, bisexual, transgender, and queer (LGBTQ)/same-sex marriages may not maintain the current marital norms that create less community participation. Greater social legitimacy and inclusion for diverse sexualities may be a consequence of these new marriages. The meaning of community life in the neighborhood and in the LGBTQ social network may be different after marriage, especially as there may be more inclusion for diverse sexualities locally and so there may be less need for new contacts. The less likelihood of having children and/or having more difficult situations with children suggests different outcomes among these couples. Recognizing the variation among families where violence is endemic and fine tuning the potential interventions and near and far term support could be assisted by some attention to both the similarities and range of differences in contemporary

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research. Fuller use of the knowledge in medical and mental health outreach with proposed interventions and support could be tempered by identifying some of the barriers and potential strengths of different problematic families (Hardesty & Ogolsky, 2020). Of course, some understanding of the criminal aspects of violence must be incorporated in such analyses. There is a range of professional judgment of what the potential for real and lasting change is for various family and household entities. For example, some positive results have been seen in families moving away from physical punishment of children (Buehler, 2020). Access to couples who have tolerated or adopted violence, isolation, and vicious arguments as their mode of action is often through the criminal justice system with very limited use of educational or therapeutic interventions. Violence against elders and disabled people has been addressed by some programming and citizen activism and is presumed to be somewhat less than previously noted. It would be useful for prevention and intervention to reduce violence activities to identify definitions of family, which can be helpful for developing assessments and interventions that may be successful and helpful in outreach and involvement. Developmental systems and transmission of violence using well-established findings from family and relationship science can be useful (Hardesty & Ogolsky, 2020). Post-separation marital dynamics often feature men who perpetuate violence, stalking, and exploiting children. Children’s exposure to IPV and harsh discipline is problematic. Khaw and Hardesty (2009) in the first issue of the Journal of Family Theory and Review launched a now classic approach to understanding and supporting the victim of marital couple abuse becoming enabled to leave a relationship that had violence as a recurrent component. This breakthrough in conceptualization was fundamental to reaching scholars, professionals, and the legal community in escaping the conundrum seeing family violence as immune to intervention. The impact of governmental laws and policies on how families are defined, become eligible for benefits, or meet regulations, and are given responsibilities and held liable for action is a major project as these policies change frequently. “Policy levers …may include direct or indirect transfers …in the form of cash or in-kind assistance as well as direct service provision” (Berger & Carlson, 2020, p. 479). The differences in programs and legal guidance are significant and vary in the ways state and local entities formulate and interpret these structures. Who can be counted on in stressful situations or looked out for long-term well-being may not be those who are ordinarily expected to do so. For example, grandparents or uncles and aunts may be called on to support or replace parents who are not fulfilling their family roles perhaps because of their limitations or their involvement with drugs, medical and psychological issues, unstable work, and other conflicting problems, issues, or responsibilities. IPV and sexual abuse contribute to the need for placement. The family may support or undercut each member’s needs depending on the assistance provided to each family member by other family members. The vesting of much of the marriage and family regulations to the states has led to some shopping around or establishing residency for the purpose of some legal actions such as divorce and adoption. There have been many contemporary changes in expectations

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and regulations of marriage, family life, separation, divorce, custody, and support. The concept of marriage equality illustrates how in rather short period of time same-­ sex relationships moved from being unrecognized or rejected to creating a legally recognized marriage and family entities and to being of interest to researchers (Reczek, 2020). The United States is especially complex in terms of law in general and specifically in terms of marriage and family because many of the familial issues are reserved to local and state regulations and others are affected nationally by the Supreme Court. In Europe, a similar decision to leave much of family law to each country respects and supports some policy differences in family policy and law. However, much of the European Union government benefits and regulations are centered on the individual, not the family, so that educational and medical programs are person centered (Olah, 2015). The many new family patterns and socioeconomic changes have been recognized. The United Nations has had some interest in both individual and family-oriented policies and is faced with the wide variance in legal and law enforcement across the world. The United Nations policies work has undertaken complex reviews and research activities so that there is clarity, and local support is developed.

2 Early History of Legislation and Intervention The early history of legislation in terms of action to address family violence was based on some actions to limit abuse of animals. Henry Bergh devoted his energy to the prevention of cruelty to animals. In 1866, he founded the American Society for the Prevention of Cruelty to Animals (https://www.aspca.org/about-­us/history-­of-­ the-­aspca). The American Society for the Prevention of Cruelty to Animals was the first and only humane society in the Western Hemisphere, and its formation prompted the New York State Legislature to pass the country’s first effective anti-­ cruelty law. Attorney and patrician Elbridge Gerry founded the first Society for the Prevention of Cruelty to Children in New York City in December 1874. Gerry’s involvement in the rescue of an eight-year-old girl, Mary Ellen, from her physically abusive guardians had persuaded him of the need to organize a society to protect children. Other social movements also began to address family needs. Hull House was founded in Chicago in 1889 by Jane Addams and Ellen Gates Starr to address immigrant families and children (https://www.britannica.com/topic/Hull-­House).

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3 Family Versus Household as the Choice of Target Who is likely to be protected, exposed, or attacked continues to be central to both the debates and actions recommended and expressed. The diversity and complexity in families and households is more recognized today than at earlier times in our history and across the world (Berger & Carlson, 2020). Individuals are likely to have overlapping resources and responsibilities in more than one household or family. The scholarly community has become more broadly based in examining family issues. We have begun to notice many more issues that have bearing on the impact, and response to family interactions and outcomes is interdisciplinary and many of the larger studies are funded by government or private foundations. Some of these variables may also be added to other studies that pursue other primary topics. In terms of IPV, much of the early work was supported by the investigators and small grants in aid, as this area of study developed instruments that could be used in larger studies with many other variables. Being clear about how research is done and presented requires that queries and techniques are specified so the work is comparative and later studies can build upon them. Because the issues in IPV occur primarily within families, it becomes important to describe the family context. However, the overlap with terms and concepts in law, education, mental health, counseling, and therapy also needs to be explored and specified. Violence in the everyday life of people has been difficult to describe, but is important in order to find ways of addressing violence and to recognize its impact and develop strategies for making a difference. Hardesty and Ogolsky (2020) described how affluence, including privacy and public perfection, keeps IPV concealed. Many families hide any violent incidents. Abused wives and children may be pressed to maintain confidentiality. Physical aggression is often hand in hand with other coercive measures that keep those who are involved away from any other support or release from the perpetrator’s control. Even when the situation is identified and there is opportunity to get a legal settlement or relief, the aggressor may be able to use legal strategies to slow down or prevent a settlement.

4 Legal Discussion Marriage and Family Regulation Although religious organizations are not vested with the control of family practices and marriage, in the United States, clergy and some others are allowed to conduct marriage ceremonies and may decide whom they will serve. Civil ceremonies are also available. If a family is associated with a religious group, they may be likely to see that group’s family expectations as more relevant than the current family policies and laws.

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Positive support for physical punishment and other harsh parenting may reach families through generational family practices, and religious or cultural identities. For example, the fear many parents in Black communities have for the safety of their children may lead to using physical punishment or signing releases for school corporal punishment. The high rate of expelling minority children and youth from schools is a major driver of parental concern and choices in treating their children.

Litigation Once the recognition of the family members having left a marriage or living together partnership becomes enshrined in a legal finding, some further expectations may also be formally identified in court orders or formal guidance from child welfare or mental health agencies. The great dynamics of family life after divorce or separation are the formal return to court and/or the formal finding on who can do what and who must do what becomes actionable. Divorce or separation can be amical, and the new configurations can be easy to maintain. However, there may be anger and ill-will that hang over all subsequent actions. Courts are, of course, developed to settle disputes hopefully without violence being the outcome. It is clear that in some ways the lawyers represent the idea of fighting for the right outcome. When the parties do not buy into allowing the outcome of the legal action, further litigation or violence often follows. Divorce itself has many different meanings over time. With shared children, reunions happen for specific purposes and sometimes even shared intimacy. On some occasions there may be a re-identification as a family for that limited purpose. There are other situations where extended family and close family friends may still expect participation of former spouses in larger family events. As many people across long lifetimes accumulate intimate relationships that may have been recognized by their other relationships, they may make some sort of new or revised commitment that continues to be part of their self-identification and sense of family. Family members may renegotiate their relationships in both intact and broken families as adult life offers a more even power and influence to all. Finding a balanced and voluntary interaction may be possible and really rewarding. Also, when parents are elderly, they will need a relationship that is positive and trustworthy with each family member. The sheltering of older people by younger relatives does present another venue for exploitation or abuse and it is important to take protective steps in advance.

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Marriage Law In terms of getting married in the United States, one of the parties should have legal residence at the time of the marriage. There may be other requirements state by state and the various other entities such as District of Columbia and the Puerto Rico. Marriage law in the United States is a state prerogative that includes the right of clergy to marry a couple and some legal ascribed people such as a judge or justice of the peace may have that authority. Currently most adults could also be ordained online and may have the right to perform marriage. Getting a marriage license may also have other requirements and waiting periods. Destination weddings have become more popular and may have other stipulations. Gray divorces for older Americans are going up as well as remarriages later in life. Shifting to later age for marriage as well as the greater education level has delayed divorce (Buehler, 2020).

Mandated Reporting The key change in the 1960s addressing case finding and oversight was the legal construction of the “mandated reporter” who was required to report any suspicion of abuse, but the reporter was not held responsible for the investigation and that the reporter could not be sued for making the report. The failure to report became the crime. While these were state laws, they were quite similar, but now seem ambiguous (Lytle et al., 2021).

Consequences of Legal Reform There have been several important legal changes that allow a better sense of empowerment against exploitation, and mental and physical injury. The inputs of parents into policy making were part of the movement to change the way we met the needs of disabled children and adults. The American with Disabilities Act for over 30 years has signaled a change in approach on disabilities care and treatment and community expectations for accommodations. Harris (2020) suggested: “Rather than silo disability or limit conversations about disability to the antidiscrimination realm, we ought to deploy disability as a critical lens across various areas of law. In this sense, disability should be a diagnostic lens, as race and gender are, to better understand discrimination and construct ex ante, as well as ex post, legal interventions.” The parents and professionals created movements opposed to the use of group living institutions to treat disease and disability, mental illness, provide for orphans and neglected children, care for the poor, and care for the elderly changed the way support is delivered. It also got rid of limited access to programs by parents.

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Although prisons are still placed far from the communities of the inmates, there is more acknowledgment that visitation is helpful. The development of planning for children with special needs in educational settings with parents has also led to better outcomes.

Other Ties and the Role of Location in Government Programs While most households operate in one locale and include some relatives and close friends who are “fictive kin,” many people have few active ties and often these people may be located outside the area where the help is needed. The ownership that state governments use in their dealings with older persons and their supportive caregivers can be quite significant. While federal benefits programs provide the financial support to the individual in need, the state administers how and to whom it is distributed and what role an outsider not resident in state can play. In this context, the patient becomes captive where the first use of programs happened. It is often possible to increase the oversight of the care of a patient or a person with limited decision-­making power, but the likelihood of moving them to another state after accepting funding there is unlikely even if there is no local relative. Hastings and Schneider (2021) suggested that family structure is a source of inequality in investments in children over time. Biological children living with biological fathers receive more than those with socially related fathers. Single parents give the most in terms of their resources. Cooney (2021) found the extension of significant grandparent support was documented to the families of cohabiting and single mothers, including never married or divorced, and suggested that it highlights the solidarity and adaptation families today.

5 Research The continuing development of the study of family and partner violence has been advanced by improving data gathering and measurement. The development of measures has had an impact on the expansion of research on aspects of interpersonal and family processes. IPV has become a more commonly included measure in many household and family studies. More recently, a measure for individuals experiencing adverse childhood events (ACEs) has also been added to many studies. The measure of ACEs is an example of a concept founded on a measurement based on a set of questions. The score is given to the person or to a knowledgeable informant who answers a set of questions about that person’s adverse life events. It yields an ordinal scale that treats each event as one item, which can be summed. It was derived from several questions about life events in a Centers for Disease Control and Prevention (CDC)–Kaiser Permanente Study of 17,000 members of their health treated as a group, and these binary answers could be summed and the total treated

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as a single variable, which had strong relationships with other characteristics or outcomes. The National Survey of Children’s Health was conducted in 2003, 2007, 2011/12, and 2016 in all 50 states and the District of Columbia. The 2016 National Survey of Children’s Health was funded and directed by the Health Resources and Services Administration’s Maternal and Child Health Bureau. The 2016 National Survey of Children’s Health study was significantly redesigned and differed from the prior survey cycles; therefore, comparisons cannot be drawn across all years of the survey. A parent or guardian knowledgeable about the child answers questions about the child and themselves. In a relatively brief time, ACEs became well adopted in both medicine and education as a screening tool and were frequently used in quantitative research (Ignacio et al., 2022). The attraction of this instrument is that it is not so tied to the fact of living in a vulnerable community as a measure that had been used previously. Much like domestic violence and child abuse, social status did not protect families from having experienced some of these events and some families living in poor circumstances did not have as many of these events as might have been expected. There is currently interest in the widespread use of this measure for making health and education policy and program decisions.

Historic Roots of Current Family Violence Activism Violence is a major societal-level issue that provides a context for viewing interpersonal violence between relatives as an important element. Straus et al. (1980) chose to do a survey in 1976 that asked about violence using a conflict tactics scale that looked at conflict resolution methods of rational discussion, verbal and nonverbal expression of hostility, and physical force or violence, which contributed to creating an awareness of the importance of understanding the family impact of violence. At this same period more attention was being directed to violence against children and child abuse (1980). Straus and Kantor (1991) also studied physical punishment by parents as a risk factor as well as several related issues including depression, suicide, alcohol abuse, child abuse, and wife beating. Data developed by emergency room doctors in Denver, Colorado, led by Dr. C.  Henry Kempe who coauthored “The Battered Child Syndrome” with his wife Ruth pioneered treatment and detection of child abuse (Kempe et al., 1962). They revealed that some parents whose children had been injured had avoided recognition by taking their children to different emergency rooms around the city. Similarly, partner-level violence became a social and research concern accompanied by a community movement to provide shelters for women who often had no access to their family’s material support. One of the shocks to the public was the identification of wealthy and important families as having partner violence within. Stories of well-dressed women with no funds or access to support were widely noticed. Revelations of the toleration of interpersonal violence by families, related institutions, schools, health and medical organizations, the courts, and the community have been hard to remedy. From a familial point of view the issue of separation of

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IPV intimate partner violence, harsh parenting, elder neglect and exploitation, disabilities discrimination, sibling violence into different specialties, and even disciplines blocks understanding their interaction. Conflict is not likely to be eliminated in close relationships but responding to those situations is possibly amenable to change. For professionals who have responsibilities to help families cope with conflict, they need to be well educated and skilled in establishing available support in terms of legal, educational, shelter, medical, and mental health resources. Asking, following-­up, recording, and evaluating are complex but vital processes in making a difference. For families, some level of anger and hostility may be woven into everyday life. For children, there is often some use of pain and embarrassment in parents’ negative sanctioning for “bad” behavior. Siblings may be allowed to settle disputes with violent behavior. Related negative behavior such as isolation and rejection of attempts to communicate and other aversive behaviors add to the load of negation in the family’s interactions. Neglect is an aspect of violence, which is not discussed as much as it should be. Many forces such as job quality, economic volatility, and incidents such as incarceration or housing loss may contribute to instability and uncertainty (Cooper & Pugh, 2020). Lack of school supplies, proper clothing, or gym shoes creates embarrassing situations for students. Even school lunch programs are often delivered so as to label the children who need the food. Discrimination is often evident. The pressures parents are under in work, caring for other family members. or the fact that some of them are missing due to incarceration or work demands just does not seem to register when designing outreach programs and interventions (Cooper & Pugh, 2020). Being willing to work with whatever family is available might improve our systemic chances of making a difference. For example, grandparents and cousins were helpful in providing placements for children during the substance abuse epidemics that affected their parents (Berger & Carlson, 2020). Hidden family violence has been labeled intimate terrorism, as different from situational violence tied to specific conflicts and emotions that escalate into violence. Family has been seen as a haven of protection for children, women, and the elderly without really addressing how much violence and threat of violence is often sheltered behind this belief. Communities may have great problems in general In which family violence has limited impact. Some affluent communities may not recognize violence and exploitation occurring there in the “private family” (Hardesty & Ogolsky, 2020). Prevention requires awareness, knowledge, and the desire to encourage safety and monitor the household and near environment. Prevention of injuries from tools, equipment, bad weather, broken items, and other near environmental causes requires some grasp of what safety measures can be taken and maintained and the motivation to involve everyone in the work of prevention. Having proper safety measures and using the right tools for maintenance can also cut back on injuries and death. The role of these dangers in compounding interpersonal conflict and violence and associated stimulation of resiliency processes is important (Buehler, 2020).

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Conflict among family members is a beginning for potential use of physical and emotional abuse. If one’s own upbringing included abuse and physical violence, it is more likely for the new situation to replay experiences. If no interventions have been experienced, people may not even be aware of the new choices that could be made. Depression and other mental health issues are often tied to self-harm and expressive violence. Dangerous activities are often seen as important ways to be seen as brave, courageous, and competent. Daring is a way of being seen and respected by peers and others. Sibling competition and teasing also can lead to daring and lack of proper caution. The intermixing of many moods and commitments can bring danger into play without clear adherence to values and principles for safe outcomes. To develop a program of prevention requires awareness and knowledge and the desire to encourage safety and monitor the household and near environment. Prevention of injuries requires some grasp of what safety measures can be taken and maintained and the motivation to involve everyone in the work of prevention. Having proper safety measures and using the right tools for maintenance can also cut back on injuries and death. The role of these dangers in compounding interpersonal conflict and violence and associated stimulation of resiliency processes is important (Buehler, 2020, p. 156).

6 Family Caregiving The picture of a nuclear family with a few children and no one else involved in daily home life has continued to be the fall back for defining family in many discussions and policy development efforts. However, the wide variety of families is always a necessary correction as such programs are launched. In the Coronavirus Disease-2019 (COVID-19) pandemic, families have been called on to support other institutions especially schooling at home for their children, and monitoring health and exposure risks. Focusing on adoptive parents they found parents concerned about finances, children’s well-being, and social functioning, but the researchers also found parental resilience to be remarkable (Goldberg et al., 2021). Monaco (2021) reported on same-sex couples in Italy who were dealing with the relatively difficult legal paperwork and recognition of only one as parent during the early part of the pandemic; he found them to be successful in meeting the needs of the children. Grandparents have been notably called upon to deal with situations where one or both parents are problematic. For example, they may be asked to help when either or both parents are unable to handle current problems such as drug addiction, unemployment and underemployment, childcare under stressful conditions such as COVID-19, or other situations, such as mental health, where community institutions are not responsive.

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Relative Care Only rather recently did relative care for children in formal foster care give more attention to promoting relative and specifically grandparent care. The fallout from greater use of criminal internment for drug cases and some other causes has been to see other relative placements as possible and useful. The survival of harsh parenting may taint many of these relationships, and careful case work and family life education is essential. While our governmental programs are organized around the ages of the persons to be served, families are often challenged by providing care and support for everyone in their close ties and may be overcommitted both emotionally and physically and include a broad spectrum of age, abilities, and care challenges to be handled by under-resourced families and households. Defining family as a political entity has contributed to setting up barriers to movement and limited potential destinations. It is quite possible for persons and their families to be without any country or any eligibility to legally stay or pursue citizenship anywhere. Definitions are not simply convenient foundations for discussion or debate, as they are memorialized in law and regulations, and they become an instrument of exclusion or inclusion. Changing these regulations may have unforeseen effects on who is eligible to enter and stay through immigration (Smock & Schwartz, 2020). Families have been reconfigured with many more types of relationships becoming acceptable and with individuals living in more than one set of familial ties. Also, living together, same-sex marriage, divorce, remarriage, adoption, living on one’s own, longer lives, and greater diversity have shaped the obligations and opportunities among and between family members. Some find the complexity and reality overwhelming or not providing the type of support needed. Step-relationships may flourish and augment ties or create larger gaps and potentially negative experiences. Families may live as small nuclear units, or as children are shared among the parents and grandparents and new families formed by remarriage or moving in with other relatives, some relatives may not find a new love and intimacy or indeed be unprotected from conflict and violence. Family is simply now recognized as being complicated and interesting both in research and policy. Family and friendship groups provide other sorts of settings for violence, accident, or injury events to happen, because of common activities in communities (Hardesty & Ogolsky, 2020). It has been difficult to develop interventions and prevention strategies that meet their needs. There may be models from successful programs to reduce injury in other situations. We now have somewhat fewer drunken driving fatalities and other injuries by car have been brought down by better design and safety features. Sports and recreational injuries still are likely causes for accidents even with protective gear. Better design and upkeep protect against household injuries and deaths, but ladders and other access equipment and power tools still are problems. A pattern of accidents does suggest that some of the concepts on violence may be useful. For those families, such as Black Americans, may experience earlier deaths, racial discrimination, structural challenges and risks in relationships, more frequent

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bereavement, and exposure to loss, and that these losses occur earlier in the life course, raised stress, feelings of vulnerability and hypervigilance occur, and health decrements may result (Umberson, 2017). Early losses may alter attachment and social ties and more frequent losses may lead to cumulative disadvantage. The deaths of Black family members at younger ages have impacts beyond the family household and have behavioral, cognitive, biological, and social impacts over lifetimes. Similar patterns may be seen for native populations and in areas like Appalachia where the opioid crisis caused early losses. Umberson and Thomeer (2020) recognized broad influence of many family ties on health including children, siblings, and grandparents, but focused on family structure and transitions, family relationship quality and dynamics, and innovations in data. In examining how stress proliferation may affect children as measures have begun to be more sensitive, include mental health indicators and specific health measures. Spanking is a significant stressor having adverse health effects. They proposed that investigations and interventions could be improved by seeking to characterize the stress universe that children or others live in as a key to understanding the impact on family members. Links to some health problems such as depression, childhood obesity, and asthma/bronchitis illustrate the connection. Children may be direct actors in sharing family resources according to an English sample (Chzhen et al., 2022). Various broader stressors such as poverty, social position, instability, distressed parents, and caregivers and mother’s exposure to IPV contribute to a stressed family profile and poor health resources and outcomes. Adult health is also tied to stable relationships, although the material welfare seems entwined with the result. The possibility of parent education and professional awareness of these linkages is a route to changing behavior in positive ways. The assumption that violence must be physical to be counted is questionable. Several descriptions of how dyads maintain living together with repeated violent incidents suggest that family violence can be maintained unless some intervention or event brings others into the situation. The use of physical punishment in child rearing still continues after much research has negated its efficacy. Where physical punishment has lost favor, some of the new strategies are not wholesome either. Emotional aggression and isolation strategies have similar problems as physical sanctions. Recognition of violence in the everyday life has been difficult to describe, but it is important to find ways of addressing violence to recognize its impact and develop strategies for making a difference. Many families hide any violent incidents. Abused wives and children may be especially pressed to maintain confidentiality. Physical aggression is often hand in hand with other coercive measures that keep those who are involved away from any other support or release from the perpetrator’s control. Even when the situation is identified and there is opportunity to get a legal settlement or relief, the aggressor may be able to use legal strategies to slow down or prevent a settlement. Carcirieri, Fleury-­Steiner, and Miller (2019) found that mediation services did not usually benefit wives who were urged to accept it in civil protection orders. The pressure to speed up orders by waiving a full hearing means that

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the abuser may get consent to an order without admitting to the court record the abuser’s action on the record. Self-perception is open to being imperfect in processing what is going on among family members and those they pay to assist in care and management. Abuse in that setting likely includes neglect or poor timing. Getting one’s preferences clearly and legally rendered often fails because of waiting too long for it to be legally stated. One’s hopes may cause overlooking actions that are not in the person’s best interest for the near or far term. Also, today’s complex governmental or institutional programs require appropriate management assistance to get good outcomes (Berger & Carlson, 2020). Knowing one’s own limits can be helpful in avoiding getting advice that is tuned to another’s best interest.

Perception of Others One’s friends, work relationships, extended family and their friends, neighbors, and leisure companions are just a few of the ongoing contacts that have a niche in which others locate you. People go, come, and go, but many relationships are long term. Some may be because your life matters to them and vice versa. Others such as neighbors and work mates may just have a superficial ongoing strand of shared interests. Sometimes, one may be surprised to know that a casual relationship may develop to be more important. Being able to evaluate changing circumstances is easier for some people than others. One of the immensely sad aspects of jealousy and often violent relationships is attempt to isolate the individual or couple from others. Being recognized as such by relatives, neighbors, co-workers, and friends, expectations, support, and concern often flow into their lives. Ignoring or dismissing them can isolate or simply not be a potential support when stress or anger occurs with violent outcomes. When these relatives and close ties are aware of the difficulties and distress, they may not feel or know or be able to seek community or legal support. When the situation contains other legal issues or penalties, children and youth may be punished as well. Even though grandparents are often the emergency caregivers for their grandchildren, they usually are limited by the legal presumption of parents’ right to raise their children. One of the findings during the opioid epidemic was that a wide variety of family and close relationships were also helpful in caring for children and youth and reduced placement in foster care.

7 Legal and Therapeutic Intervention and Family Violence If our professional assessment is to be clear and accurate, we need to be open about our definitions and methods to make clear the locations and people who may be related to our findings and applications. There is a great variety and many

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differences in how people view both their own family and other close ties, but also how others view the situation. The impact of governmental laws and policies on how families are defined, become eligible for benefits, or meet regulations, and are given responsibilities and held liable for action is not a minor issue. Who can be counted on during stressful situations or looked out for long-term well-being may not be those who are ordinarily expected to do so. For example, grandparents or uncles and aunts may be called on to support or replace parents who are not fulfilling their family roles perhaps because of their limitations or their involvement with drugs, medical and psychological issues, unstable work, and other conflicting problems, issues, or responsibilities. IPV and sexual abuse contribute to the need for placement (Hardesty & Ogolsky, 2020). Depending on what relationships are providing to each family member, the family may be supporting or undercutting each member’s needs. The vesting of much of marriage and family regulations to the states has led to some shopping around or establishing residency for the purpose of some legal actions such as divorce and adoption. There have been many contemporary changes in expectations and regulations of marriage, family life, separation, divorce, custody, and support. The concept of marriage equality illustrates how in rather short period of time same-sex relationships have moved from being unrecognized or rejected to creating a legally recognized marriage and family entity (Reczek, 2020). Intersectionality theory suggests that more than one aspect of the situations that families experience may provide a complex, but rather united situation in which multiple positive and/or negative factors work to set possibilities and resources and to create the options open or closed to them (Few-Demo & Allen, 2020). The various areas of disadvantage or advantage often appear to be seamlessly connected, so there are limited expectations that direct any attempts to alter outcomes. Sherif Trask (2018) noted that racial and ethnic group membership and global processes create a different approach to life course and how experiences are refashioned throughout life and within the greater diversity that is characterizing families everywhere. Life course has become unpredictable and less stable. Cohorts, specific age groups, have different experiences at the same historic events. Gender orientation and transnational motherhood has altered women’s lives both in terms of some hardships and new opportunities. In family sociology, social class was often the explanatory variable linking opportunity and disparity to people’s lives. A more focused approach views many different aspects of everyday life and intergenerational ties and how these differences create options and opportunities or prevent mobility and new options (Fingerman et  al., 2020). This intersectionality theory suggests how family and community interact to provide new options or limit mobility. Young adults are often still connected to their families of origin and daughters continue to play a central role in articulating relationships. Fingerman et al. (2020) noted that approximately 40% of midlife and older couples with children were in stepfamilies. They call attention to estrangement as well as situations where members, such as fathers, are deceased, never were present, or are incarcerated. For example, it is more common for Black youth to have a parent gone. Umana-Taylor and Hill (2020) noted that “most consistent finding was the positive association between the domain of cultural socialization and youth adjustment” (p. 281).

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Legal Definitions and Processes The broad swath of laws and regulations that recognize, regulate, and define families and households makes it challenging to suggest and implement policies and programs that seek to strengthen and support well-being for the wide variety of families and households. For example, divorce laws and processes that are accessible, fair, and careful about the outcomes could be seen as a strategy to allow distancing among family members, which may relieve ongoing conflict and abuse. Many legal systems have been increased in the scope and types of relief available to families and individuals. In marital and family law, the concept of “bench law” acknowledges the role judges play in interpreting law when making findings. Sometimes this informal recognition is exercised by the legal community and efforts are made to come before the more responsive judge or be aware of different professionals’ views in the local child and family agencies. Most couples who seek and get divorces assume that is the major decision. However, for many couples, divorce is just the first of many returns to ligation as the new configurations still generate disagreements and when there is failure to deliver on the legal divorce findings. The family-­ oriented events that may bring estranged family members together may also promote further conflict or unwanted intimacy. Other legal issues with the individuals in the family matrix may threaten the stability and functioning of the unit. Legal action on drug use and distribution has often resulted in different outcomes for couples. If the husband is the main actor in the illegal enterprise, he might have some knowledge that could bargain for a lesser sentence, where the wife’s lesser involvement might not give her similar bargaining power. Communities take for granted the losses children and youth incur from their relatives’ incarceration are appropriate. Grandparents, aunts, uncles, and fictive kin are often involved in caregiving and support when parents are unable to meet their responsibilities. Much of relative and friendship care is informally arranged, but if the situation is serious and long lasting some legal oversight may be needed. When children frequently face several families when receiving care, other issues of quality care arise with children often being asked to be more mature than the adults in managing the connections and disputes. Almost all of our institutions are laced with violence. Family is particularly noted because violence is both hidden and in certain situations expected and supported. The public shooting of available groups of people often with both murder and suicide has become a recurrent ritual followed by a number of standard responses from law enforcement, school administration, politicians, clergy, parents, “experts,” and commentators. The mourning and the funerals provide the transitions to learned helplessness and symbolic processing that seldom result in any change. The wait for the next incident is often a short one. Schools, religious sites, hotels, crowd events, and shopping centers are also easy targets for violence from many different types of perpetrators and often strike at several family members in these settings.

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An important aspect of the legal process is getting legal relief. Some changes had been incrementally made at the state level for both family choices/responsibilities and individual liberties. Some practices have been changed in the direction of less discretion for individual judges on interpreting the law and legal remedies. The advice to be sure your lawyer is paid to work for you and by you, is still important to outcomes when members of families seek different resolutions for disputes or severing of ties.

Consequences of Legal Reform Some of the important characteristics that have been defined and regulated as part of legal reform include the age of consent, which has been defined in the different states and agencies usually to limit very young marriages, but often there have been work arounds for young women who are pregnant. The usual arguments on age refer to the ability to legally consent to marriage or sexual intimacy. Delaware has moved to do away with these exceptions allowing young marriages. Family violent behavior is often shielded from public view to the extent that housing is somewhat private. Spousal abuse had long been ignored and when the movements to research domestic violence and provide shelters and legal support became locally and nationally recognized and supported both by community and court action, the situation changed radically. Many more cases were recognized by police, teachers, doctors, child welfare case workers, and others who held positions that provided access to the families and households at risk. Despite various campaigns to eliminate physical punishment of children and youth and the revelations about spousal and elder abuse, they have not convinced many more people who might know about the harsh behavior to intervene or report. The recognition of “domestic” violence was often focused on specific spousal, elder, and infant abuse. Attention to children’s discipline, sibling abuse, and playmates’ rough interactions has been slower in gaining attention and response. The fact that our census data are built on querying by residences also has made it troubling to perceive that the dynamics of pair and family interactions are located beyond a single residence. The use of separation and divorce to relieve contact with a violent person may not fix the situation in terms of support and access. Interpersonal violence takes many forms and may be augmented by threats and isolation. The use of household items as weapons is common and raises the consequences of threats higher. The wide distribution of guns and lack of training in safe gun use have led to dangerous situations in households and among family members. “Accidents” and “incidents” may not lead to identifying dangerous situations, when the family network is not aware of the ongoing system that keeps couples and families in repeated aggressions. Automobiles and other vehicles may play a role in fleeing from violence or provide a dangerous situation for argument and/or physical violence, or pursuit of the oppressor. Any brief assault or angry verbal attack or threat can rapidly escalate when there is no one to deescalate or challenge the

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interaction. The connections among different aspects of negative actions both verbal and physical are seen by experts, but often not. Fingerman et al. (2020) noted that those three processes of interpersonal dynamics may stir or impel some action; instigation may trigger a violent event. The impulsion to act aggressively may follow stirring emotions, possibly followed by inhibition building self-control, and self-regulation superseding violence. Developmental systems may include transmission of violence as shown in “well-­ established findings from family and relationships science” (p. 461). Post-separation dynamic features “men who perpetuate violence and stalking” and some parents negatively exploit children to carry on post-separation harassment. Both exposing children to IPV violence and harsh discipline were noted as problematic. Harsh parenting is the phrase that seems to be common to refer to parenting that includes physical punishment such as spanking and various isolation and mental or personal attacks and neglect. It does not have the burden that IPV conveys for adults of meaning violence, although the correlates of spanking and other physical punishments suggest real and long-term damage. Silveira et al. (2021) reviewed both major differences within the United States and other countries in corporal punishment. They noted that the more common use of corporal discipline in Black families may be seen as a way to protect Black youth from the realities of racism. In the United Kingdom, all ethnic minorities had high use of physical discipline. White parents were more likely to use time out across all the countries included. The use of spanking appears to have negative substantial consequence well into adolescence and adulthood. Self-regulation appears related to positive discipline. Zyara et al. (2020) in a study of rural families identified that some families’ households were chaotic and while they were not violent, they were not providing the support needed. Klein and Olsey (2018) suggested that women have to pass a higher standard of expectations for what is violence. Anger and contempt most rise to a higher threshold level, although they are the strongest predictor of IPV. In the United States, legal system laws and enforcement exist in at least three layers, local, state, and national, and families are defined and regulated primarily at the state level. Some important exceptions, such as the Supreme Court findings on allowing interracial marriage in 1967 and marriage equality in 2015 for same-sex partners, have changed the definitions of marriage and family nationally and brought these dyads into state law (deGuzman & Nishina, 2017). One must show residence or some other ties in order to qualify for acting within a specific state’s law and seeking action. For family, some key laws are quite different in the various states, and one may be treated differently. If one’s legal home is elsewhere or if a family is defined as not in keeping with the composition of the state’s legal definition for family, relief may not be obtained. On the global level the range and scope of family legal regulations are broad and complex. For example, the European Union countries still maintain family regulations by countries, but most EU welfare and health programs affecting families are administered by serving individuals or dyads and not being defined as family programs. A family research center, European Observatory on Family Matters, was for many years the main collective European effort on families. In recent years a

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collaborative research effort across Europe has promoted comparative family research and collaborated in other international family research. The European Platform for Investing in Children is an evidence-based online platform that provides information about policies that can help children and their families face the challenges that exist in the current economic climate in Europe.

8 Guns and the Intersection with Families American families are at great risk from gun violence both within the family itself and in the community and in “imminent danger with firearm related death 10 times more for likely for those in the United States than any other high income country…” (Sanchez et  al., 2020, p.  2169). In summarizing their review, they suggest that: “access to firearms + violent or aggressive behavioral tendencies or risk factors + psychiatric disease or mental illness causing a defect of reason and impaired judgment = gun related injuries.” They also noted that over 67% of US population would favor a ban on assault weapons. Our policies at both the state and national levels make it relatively easy to get a gun and ammunition at young ages. The uncertain, but numerous, violent incidents in which perpetrators seek out children, adults, minorities, communities, religious groups, schools, shopping centers, outdoor activities and recreation facilities, makes it clear that violence does not only come from within families and/or friendship networks, but is visited upon them by isolated, suicidal people who may have no particular connection to them. Sanchez et  al. (2020) in a broad review of the literature noted that “prior gun injury and engagement in serious physical violence or fighting predicted gun access” (p. 2470). The increasingly efficient weapons widely available to would-be shooters have been effective in killing and wounding larger groups and, while often the shooter dies, the impact makes it an event that adds to the overall fear and to the likelihood of repetition (Sanchez et al., 2020). There are those who argue that more armed people in these situations would shift the dynamics and present an option for defense; however, reports of those seeking to face violence failing to make a difference are common. Being in the situation of attempting to meet violence with violence has not been found to be effective in either prevention or in the incidents themselves. Even when police, teachers, gun owners, etc., are trained in defense and/or counterattack, fewer lives are saved, and more violence occurs. We have relatively little evidence of any connection between mental illness and gun violence and injury prevention and control (Sanchez et al., 2020). They used a very wide search of related articles and a systematic selection process. Children reporting bullying victimization had increased likelihood of access to a loaded gun without adult supervision. “Other lacks in positive resources were implicated. Situations of low access to positive resources, poor social relationships, drug and alcohol use, community violence, drug trafficking, felt lack of safety, were likely to lead to gun carrying for adolescents” (Sanchez et al., 2020, p. 2171). While some had mental health problems or conduct disorders, the vast majority of those with these problems were not reporting

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gun carrying or other acting out behavior. Thus, there is an important role for a public health approach. If a weapon is at hand, the threat is much higher for risk of major injury or death and of collateral injuries (Scheimler et al., 2021). A person at risk of using gun violence is one who has access to a firearm and is depressed or who has lost some hope of change. The easy availability of guns is also a more likely completion of such attempts. In reviewing research from the period of the COVID-19, they noted a sharp increase in gun purchases and in firearm violence. At a greater level of context, violence is not confined to those who are within some household or family context. American families are living in a situation where almost everyone over 18 could be armed and dangerous. Firearm purchasing is widely part of the American scene. Even during the COVID-19 pandemic, March through July 2020, a study identified 4.3 million excess firearm purchases nationally (Scheimler et al., 2021). This uptick was associated with an increase in home and other injuries in that period in April and May. In 2020, Bradbury-Jones and Isham called for attention of the nursing profession to be aware of the potential of escalating domestic/family violence including IPV, child abuse, and elder abuse due to lockdowns and isolation. New Zealand, Brazil, Spain, Cyprus, and the United Kingdom, also reported to have higher rates of domestic violence. Concern over homicide was already being illustrated and supported by data, and worry about the difficulties of extending useful help was foremost. A hidden pandemic of family violence during COVID-19 was assumed because other pandemics such as Ebola had shown increases in domestic violence, and estimates showed increases of 10–25%, so other tools for estimating impact were needed (Xue et al., 2020). Their tweets online from spring 2020 were analyzed for violence content. Among the topics that garnered support were increased vulnerability during COVID-19 to violence, homicides due to child and adult violence and mental health issues, issues of social services and law enforcement, and other news and services about violence. Also, highly publicized domestic violence incidents were prominent. Compared to other types of suicide, doing a public shooting is linked to the knowledge that it will receive great public attention, which is also an incentive for public violence instead of private settings. The tools for killing large numbers of people by a single or small group are easily available and relatively inexpensive. In addition to purchasing firearms specifically for these events, many American homes are highly equipped with them. In many states, an 18-year-old youth is too young to drink alcohol legally but may purchase firearms. For many years there was a difference in the outcomes of suicide attempts with males being more likely to be completed than females, because of their choices in the attempts. Briefly, the US Centers for Disease Control and Prevention (CDC) began to research on gun violence. In 1993, the New England Journal of Medicine published an article by Kellerman and colleagues, “Gun ownership as a risk factor for homicide in the home,” which presented the results of research funded by the Centers for Disease Control and Prevention. Jamieson (2013) reported that the American Psychological Association had provided support for firearm-related injury research at that time. Their 1993

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study found that keeping a gun in the home was strongly and independently associated with an increased risk of homicide. The article concluded that rather than conferring protection, guns kept in the home are associated with an increase in the risk of homicide by a family member or intimate acquaintance. They found, for example, that a gun in a household was more likely to kill a family member than to rebuff an intruder. This kind of information was unwelcome to many in government and their constituencies and therefore violence was dropped from funding. Roubein (2022) remarks on the resumed government support of gun violence research as having much work to make up. The disputes over whether and how to address gun violence in the United States have never been simple or easy to understand. Pro-gun politics are not just about the policy or the actual acts of violence. Esposito and Finley (2014) developed a discussion that linked the market ideology of neo-liberalism theory and pro-gun politics and how they allowed gun violence to flourish in the United States. Major arguments explored the dangers of “big government,” the virtues of “rugged individualism” and “self-reliance,” and the reduction of gun violence as a personal problem of evil, sick, or irresponsible individuals. Specific to gun violence, they suggest the quasi-sacred stature to the Second Amendment in justifying personal responsibility, supporting “rugged individualism”—a hypermasculinity to protect what is “his” in a market society—and understanding that unjustified gun use is a personal trouble. In this line of thinking individuals exert their choice and decisions in their own best interests and encourage a government of service to the market. The threat of gun control in this might be understood as affecting the heart of the Second Amendment. “Doing masculinity” is often understood in this framework as acting aggressively and exercising their dominion over things. When feeling less empowered, they may act out in a “violent and spectacular fashion” (p. 87). This reaction may be domestic or public. Challenging this system of allowing violence to be perpetuated at the individual and family level would require resisting the neoliberal justifications for its existence. Lynch et al. (2018) discussed how Kentucky, as a rural state with two large urban districts, has coped with firearms and violence prevention activities. They used key informants to explore victim services and criminal justice professionals from one urban community and four rural Appalachia communities. Domestic violence, gun control policy, and implementation of gun confiscation were the topics explored. They noted a 2017 poll that showed 55% of Kentucky adults keep a firearm at home. They also described the rural under-resourced and often ignored communities as having greater poverty and isolation. The authors also noted a lack of enforcement of domestic violence orders and seeing violence against women as a lower priority. The situation also was described as not only more homes having guns, but also passing guns along as an inheritance. Social conservatism means rural women may stay at home even when money is scarce. The support of guns was limited when it comes to “wife beaters” and community concern for other’s safety was a rationale for disarming abusers. Even in urban settings support of gun rights was community wide and opposition to confiscation was widely held. The second issue by community type was the idea of a hunting and fishing culture and a sentiment suggesting that

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guns are a longtime part of heritage. Women’s claims were also questioned as to veracity. The large gap in available family and legal services between rural and urban areas creates a difference in responses to domestic violence beyond the values expressed (Lynch et al., 2018). The control of firearms when there have been domestic violence complaints varies greatly in different states. In a study in West Virginia, the community support for gun availability worked against efforts to control access for those already identified as dangerous assaulters (Blackwater, Kafts. Morraco, Williams & Carbo, 2022). The cultural niche of gun activities including hunting both for recreational purposes and for food, trophies, and friendship provides strong favorable beliefs for gun use. Complex social customs create strong support for access to guns and resist ridding homes of firearms. Even when legal orders in terms of domestic violence for gun removal are made, enforcing them may be difficult (Zeoli et al., 2019). They suggest that there is ample evidence that firearms pose dangers including threats and brandishing weapons. The tool of Domestic Violence Restraining Orders is differently applied by state laws and in some states and by federal law they can enforce the relinquishment or recovery of firearms. However, this outcome is difficult to accomplish, and many Domestic Violence Restraining Orders do not function to control access to guns. Trying to identify domestic violence and provide intervention requires the use of tools to bring it to the attention of qualified professions. Both screening and reaching out to victims could become part of medical screening. Punukoliu (2003) early on urged that screening should occur in regular medical care and resources be easily available. Family and friendship groups provide other sorts of settings for violence, accident, or injury events to happen, because of common activities. It has been difficult to develop interventions and prevention strategies that meet their needs and build capacity for co-regulation. There may be models from successful programs to reduce injury in other situations. We now have somewhat fewer drunken driving fatalities and other injuries by car have been brought down by better design and safety features. Sports and recreational injuries still are likely causes for accidents even with protective gear. Better design and upkeep protect against household injuries and deaths, but ladders and other access equipment and power tools still are problems. Mass shootings continue to be a major threat and the ability to get highly effective firearms for multiple assaults makes for both policy and enforcement issues and an examination of connections to domestic violence (Zeoli & Paruk, 2020). Firearms are implicated in more than half of all intimate partner homicides. The policy implications include firearm restrictions to prevent access to firearms for potential mass shooters, which would be based on improving the justice system through better prevention of known offenders from escaping penalty or restraining orders and firearm restrictions being effectively implemented. The upshot of seeing families as a whole and as key to addressing how various sorts of violence are harbored and supported in families is a different paradigm than focusing on each type of dyad and/or seeing how it harbors violence, and looks

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forward to some theoretical work in integrating the great deal of interesting work on IPV, abuse, and neglect of children, disabled, and elderly into a larger picture of a country as whole dealing with violence and using firearms to try to feel more in control. A feasible goal for both the discipline and the countries who care may be have services and programs to foster positive and constructive relationships in families of all sorts. Running through all sorts of work on violence in the family and household settings has been the legal systems’ innovative change and impact. In this short overview, some of the substantive changes, such as how family members are affected by the system, how the federal and state programs and assistance relate or clash, and how individuals and/or families act or react, are noted. The major theme is that violence at the family level is not simple or easily understood nor is there a simple intervention that works across the board. Finding ways of getting useful data is still important. Being creative in both studying and bringing the data together is crucial. The worrisome context that makes American violence research different from most other places is the widespread adoption of guns in both families and households. We must connect the family violence picture to this immense commitment to gun violence as a sense of security personally and for families. At the same time, we, professionally, know that this phenomenon has made everyone more vulnerable and created an ongoing anxious background to every activity. We do have to incorporate some measures to trace its influence on family violence of all sorts.

9 Conclusion To begin to look at the context of interpersonal violence in families, measures that can help tie the violence measures by dyads together in terms of family interaction and responsibility should be developed. For example, the major assistance that couples who were caught up in the opioid crisis received from their parents and relatives who fostered their children was successful. The descriptions of family support and intervention needed data for this interdisciplinary field. Families that have sufficient material resources continue to need help accessing problems, and using assistance. Understanding the medical and health needs and options in families at risk is important both for professionals and for clients. To build family typologies that could be helpful in family violence would mean that most intimate and family violence studies would include some descriptive measures. The trifecta of couple, parent/child, and elder care and support could become incorporated into the same studies. A family taxonomy that is simple and informative would be useful, much as the ACEs measure of adverse events has served an important role in interdisciplinary research. Some of the approaches used in genealogy searches might also be useful. Intersectionality and security measures that can help locate families in terms of their security and options for their families could be helpful. The big changes in later age of marriage and childbearing, marriage equality, use of cohabitation as part of the

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family process, diversity of background, women staying in the workforce, divorce and remarriage, and the long-term health and mental outcomes suggest that family life can be made to work in many situations, but that we must keep aware of changing practices. Americans still seem to value independent households, but can be flexible in situations like the COVID-19 crisis. The violence dimensions in family life are made more deadly by the custom of individual gun ownership. Mass violence is common experience as well. This proliferation of access to weapons suggests that violence control is very far away. The sense that this situation is part of our culture and not open for remediation seems to be widely accepted. As yet, there has not emerged a technique to reduce family and interpersonal violence that confronts armed and dangerous members of the family. It is true that living in a dangerous neighborhood where violence is on the street or often being cut off from social support may drive suicide (Pew Research Center, 2022). However, the armed individual, family, or household is a major risk and may contribute to family and community violence. Risk and excitement are interesting in themselves and must be addressed and controlled. Finding other ways for families to feel and be secure are desperately needed. The scholarly field of family violence has been effective in documenting family violence, bringing useful ideas for intervention and support, and can now build on those accomplishments. Dissemination to the public and the political establishment could prove fruitful.

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Olah, L.  S. (2015). Changing families in the European Union: Trends and policy implications. United Nations Expert Group meeting New York, May 14–15, 2015. Perry-Jenkins, M., & Gerstel, N. (2020). Work and family in the second decade of the 21st century. Journal of Marriage and Family, 82(1), 420–453. https://doi.org/10.1111/jomf12636 Pew Research Center. (2022, February 3). Suicides accounted for more than half of the U. S. gun deaths in 2020. Punukoliu, M. (2003). Domestic violence: Screening made practical. The Journal of Family Practice, 52(7), 537–543. https://doi.org/10.1093/fampra/emg531 Reczek, C. (2020). Sexual and gender minority families: A 2010 to 2020 decade in review Journal of Marriage and Family 82(1), 300–325. https://doi.org/10.1111/jomf.12607 Roubein, R. (2022, May 26). Now the government is funding gun violence research, but it’s years behind. Washington Post 8:16 AM EST. Sanchez, C., Jaguan, D., Shaikh, S., McKenney, M., & Elkbuli, A. (2020). A systematic review of the causes and prevalence strategies in reducing gun violence in the United States. American Journal of Emergency Medicine, 38, 2169–2178. https://doi.org/10.1016/.ajem.2020.06.062 Scheimler, J.  P., McCort, C.  D., Shev, C.  D., Pear, V.  A., Tornich, E., De Blas, A., Buggs, A., Laqueur, H. S., & Wintermute, G. J. (2021). Firearm purchasing and firearm violence during the coronavirus pandemic in the United States: A cross sectional study. Injury Epidemiology, 8, 43. https://doi.org/10.1186/s40621-­021-­00339-­5 Settles, B. H. (1987). A perspective on tomorrow’s families. In M. B. Sussman & S. K. Steinmetz (Eds.), Handbook of marriage and the family (pp. 157–178). Plenum Press. Sherif Trask, B. (2018), Integrating life course, globalization and the study of racial and ethnic families: life course, racial ethnic families, and globalization. Journal of Family Theory & Review 10(3). https://doi.org/10.1111/jftr.12259 Silveira, F., Shafer, K., Dufur, M. J., & Roberson, M. (2021). Ethnicity and parental discipline practices: A cross-disciplinary comparison. Journal of Marriage and Family, 83(3), 644–666. https://doi.org/10.1111/jomf.12715 Smock, P. J., & Schwartz, C. R. (2020). The demography of families: A review of patterns and change. Journal of Marriage and Family, 82(1), 9–34. https://doi.org/10.1111/jomf12612 Straus, M. A., & Kantor, G. K. (1991). Physical punishment by parents: A risk factor in the epidemiology of depression, suicide, alcohol abuse, child abuse and wife beating. Final report EDRS. Straus, M.  A., Gelles, R.  J., & Steinmetz, S.  K. (1980). Behind closed doors: Violence in the American family (p. 310). Anchor/Doubleday Press NY. Timmerman, S., & Prikett, P.  J. (2022). Who counts as family? How standards stratify lives. American Sociological Review, 87(3), 504–528. https://doi.org/10.1177/00031224221092303 Umana-Taylor, A. J., & Hill, N. E. (2020). Ethnic-racial socialization in the family: A decade’s advance on precursor’s and outcomes. Journal of Marriage and Family, 82(1), 244–271. https://doi.org/10.1111/jomf.12622 Umberson, D. (2017). Black deaths matter: Race, relationship loss, and effects on survivors. Journal of Health and Human Behavior, 58(4), 405–420. https://doi.org/10.1177/0022146517739317 Umberson, D., & Thomeer, M.  B. (2020). Family matters: Research on family ties and health 2010–2020. c 494–419. https://doi.org/10.1111/jomf12840. Xue, J., Chen, J., Chen, C., Hu, R., & Zhu, T. (2020). The hidden pandemic of family violence during the COVID-19: Unsupervised learning of tweets. Journal of Medical Internet Research, 22(11) http://www.jmir.org/2020/11/e243661/, e24361. Zeoli, A. M., & Paruk, J. K. (2020). Potential to prevent mass shootings through domestic firearm restrictions. Criminology & Public Policy, 19. Special issue Countering Mass Violence in the United States, 129–145. https://doi.org/10.1111/1745-­9133.12475 Zeoli, A.  M., Frattaroli, S., Roskarn, K., & Herrera, A.  K. (2019). Removing firearms from those prohibited from possession by domestic violence restraining orders: A survey and analysis of state laws. Trauma, Violence, & Abuse, 20(1), 112–125. https://doi. org/10.1177/1524838017692384 Zyara, B.  J., Lathren, C., & Mills-Kooncz, R. (2020). Maternal and paternal attachment style and chaos as risk factors for parenting behavior. Family Relations, 69(2), 233–246. https://doi. org/10.1111/fare.12423

Chapter 2

Definitions and Measurement of Family Violence and Aggression: Spotlight on Intimate Partner Violence Meredith E. Bagwell-Gray, Jill T. Messing, Ijeoma Nwabuzor Ogbonnaya, and Megan L. Brown

Defining and measuring family violence and aggression have long been a topic of interest, investigation, and debate among researchers and scholars (Tolan et  al., 2006). Indeed, even the term “family violence” has been fraught within social work literature and practice (Kulkarni et  al., 2020). The purpose of this chapter is to explain why it is important to be clear about how one defines terms in family violence research and practice. Another purpose of this chapter is to guide you through a thought process to support you in selecting measurement and screening instruments that align with those definitions. Being clear about what you are measuring and why is an important step in determining how you measure it. It will also influence how you might intervene to prevent violence and promote safer family relationships. Throughout the chapter, we will specifically use the example of defining and measuring intimate partner violence (IPV) within the context of the United States, beginning with an overview of the prevalence and types of IPV and a discussion on gender and intersectionality. The chapter then will discuss common frameworks, typologies, and visual tools used to define and understand IPV, with a practice highlight on their application to identify technology-based abuse. Then, with a focus on assessing women’s risk, this chapter will demonstrate how screening and assessment tools can be implemented in practice settings, showcasing the application of definitions and measurement. Finally, this chapter will address the co-occurrence of IPV and child maltreatment and explore tensions in cross-systems collaboration when definitions and measurement of IPV conflict. Toward bridging philosophical and practice differences in cross-systems collaboration, this chapter will close with M. E. Bagwell-Gray (*) The University of Kansas School of Social Welfare, Lawrence, KS, USA e-mail: [email protected] J. T. Messing · I. N. Ogbonnaya · M. L. Brown Arizona State University School of Social Work, Phoenix, AZ, USA © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 P. Sturmey (ed.), Violence in Families, Advances in Preventing and Treating Violence and Aggression, https://doi.org/10.1007/978-3-031-31549-7_2

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a case example of using myPlan (Eden et al., 2015; Glass et al., 2017)—an intervention informed by IPV definitions, measurement, and screening tools—in practice with child-welfare-involved families. Given our positionality as US-based social work scholars and the focus of this chapter on the United States, we encourage readers to explore international definitions, policies, and practices (World Health Organization, 2022; UN Women, 2022).

1 Definitions of Intimate Partner Violence There are two major questions to be asked when defining family violence: (1) What acts and behaviors constitute “violence”? For example, does type, severity, and frequency matter? and (2) How much attention should be given to the influence of gender and power within society and the family structure? (Tolan et al., 2006). As we explore these two questions throughout the chapter, we will focus on IPV as a specific type of family violence. The term intimate partner is narrower than the term family violence, referring specifically to current or former romantic partners, dating partners, boyfriends/girlfriends, spouses, and ongoing sexual partners (Breiding et  al., 2015; Centers for Disease Control and Prevention [CDC], 2020). An intimate partner relationship includes heterosexual and same sex relationships (Breiding et  al., 2015; CDC, 2020). Sexual history is not a prerequisite for determining an intimate partner relationship in experiences of IPV; for example, if one dating partner stalks another, this behavior would be considered IPV even if the couple has never had sexual intercourse.

 hat Constitutes “Violence”? Assessing Type, Frequency, W and Severity? The first key question in defining violence is what type, frequency, and severity of actions and behaviors constitute violence. When considering types of IPV, four types are most consistently conceptualized: physical violence, sexual violence, psychological aggression, and stalking. Table 2.1 includes definitions for each type of violence from the Centers for Disease Control and Prevention’s report on uniform definitions for intimate partner violence (Breiding et al., 2015). Embedded within these definitions of type are references to the other key aspects of the definition of violence: frequency and severity. For example, within the definition for stalking, a key aspect is that there is a pattern of behavior, which necessitates an establishment of frequency. With sexual violence, there is no reference to a pattern or frequency, indicating implicitly that a one-time attempted or completed sexual assault constitutes sexual violence; that said, most sexual violence measures ask about frequency, and we contend that looking at a pattern of sexual control

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2  Definitions and Measurement of Family Violence and Aggression… Table 2.1  Overview of definitions of types of intimate partner violence (Breiding et al., 2015)

Type of violence Definition Physical violence “The intentional use of physical force with the potential for causing death, disability, injury, or harm” (p. 11) Sexual violence “A sexual act that is committed or attempted by another person without freely given consent of the victim or against someone who is unable to consent or refuse” (p. 11) Psychological “Use of verbal and non-verbal communication with the intent to: (a) harm aggression another person mentally or emotionally, and/or (b) exert control over another person” (p. 15) Stalking “A pattern of repeated, unwanted, attention and contact that causes fear or concern for one’s own safety or the safety of someone else (e.g., family member, close friend)” (p. 14).

through a combination of sexual assault, sexual coercion, and sexual abuse is an important aspect of defining and measuring intimate partner sexual violence (IPSV). For a more in-depth discussion of this topic, see the section on the “Taxonomy of Sexual Control” in the section on frameworks, taxonomies, and visual tools. Regarding severity, physical violence includes the potential for causing death, disability, injury, or harm, with potential being an important signifier. For example, physical violence can include hitting regardless of whether an injury occurs, because the act leads to the potential for an injury that could occur. Similarly, with sexual violence, an attempted unwanted sexual act is considered sexual violence regardless of whether it is completed due to the impact or harm experienced by the survivor. Intent is another element about these definitions to highlight. Both the definitions for physical violence and psychological aggression specify the intent of the person using violence, such as the intent to harm or control the partner they are abusing. In contrast, intent is not explicitly named in the definitions of sexual violence or

Box 2.1 Applied Learning When you read differing definitions of family violence from various sources, see if you can identify type, frequency, and severity for qualifying violence. You can use these three factors to compare definitions. Step 1. Compare US and Local IPV Definitions To practice, look up your local legal code for definitions of family violence or domestic violence. Who is considered an intimate partner? Are there differences in what types, frequency, and severity legally qualify as family violence compared to the CDC definitions in the United States? How do you think the definitions could impact practice for survivor who have multiple system involvement, such as the legal system, child welfare system, and domestic violence social services? Step 2. Compare US and Global IPV Definitions (continued)

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Box 2.1  (continued) Now, look up World Health Organization definitions of family violence or domestic violence. Who is considered an intimate partner? Are there differences in what types, frequency, and severity count as family violence compared to the CDC definitions and your local definitions? How does using a transnational perspective strengthen your understanding of IPV and family violence?

stalking. Instead, the lens shifts to the survivor’s lived experiences of the violence: the fear or concern for their own safety, as in stalking, and the absence of their consent, as in sexual violence. In terms of application for practice, when reading definitions of various types of family violence or interpreting research findings on intimate partner violence, attending to these key definitional aspects of type, frequency, and severity, with an eye on potential for harm and intent, is an important foundation for understanding. While the definitions of the four common types of IPV seem straightforward, they are quite nuanced and complex. This complexity will be explored more deeply as we subsequently discuss the gender symmetry debate, in which the questions of frequency, severity, and intent come into play to better understand and define IPV.

2 Gender, Power, and Intersectionality: Implications for Measurement and Prevalence Rates Another key question in defining IPV is to what extent is it important to attend to power differentials based on gendered dynamics in society and relationships. Since the 1980s, when studies began assessing the prevalence of domestic violence in the United States, a debate emerged about whether men and women equally use and experience violence in their relationships. Scholars and researchers still contend over this today. Those who hold a gender symmetry perspective suggest that violence use and victimization is the same across genders. In contrast, those who hold a gender-based violence perspective suggest that violence victimization disproportionately affects women. Further, those with an intersectional perspective agree that violence victimization disproportionately affects people of identity groups who experience historic and contemporary marginalized status based on race, class, disability, gender identity, and sexual orientation (e.g., Stockman et al., 2015; Waller et al., 2021). The differences in the gender symmetry debate stem largely from how violence is defined and measured. For example, the Conflict Tactics Scale (CTS; Straus et al., 1981; Straus & Gelles, 1986) and its revised version (the Conflict Tactics Scale-2 [CTS2]; Straus et  al., 1996) are often-employed family violence measurement

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instruments that consistently produce results suggesting men and women equally use violence as a means of resolving conflict in their intimate relationships (Gilfus et al., 2010). The CTS2 assesses for both using and experiencing physical violence, psychological abuse, and sexual violence. It also has items to indicate the impact of the violence (e.g., injury; needing to seek medical attention) and non-violent conflict resolution strategies. Items are categorized as “minor” or “severe” violence to assess for severity, and respondents identify how often these types of violence occurred within a particular timeframe (e.g., 12 months). Despite its popular use, the CTS and the CTS2 have been critiqued as measurement instruments on several accounts (DeKeseredy & Schwartz, 1998; Kimmel, 2002). As a major critique, the prompt at the outset of the questionnaire labels the violence as “couple conflicts” and uses the following prompt to frame the questions: No matter how well a couple gets along, there are times when they disagree, get annoyed with the other person, want different things from each other, or just have spats or fights because they are in a bad mood, are tired, or for some other reason. Couples also have many different ways of trying to settle their differences. This is a list of things that might happen when you have differences. (Straus & Douglas, 2004, p. 518)

This prompt primes the respondent to think of violence as occurring because of disagreements as a means of resolving conflict. However, much of the research on IPV points to a context of coercive control, with violence that occurs intermittently, unexpectedly, or cyclically as an attempt to retain power over the victim (Dutton & Goodman, 2005; Pitman, 2017; Stark, 2007). Further, it is argued that an incident-­ based measurement approach such as the CTS2, which tallies the number and types of acts of violence, fails to adequately capture the pattern of coercive control that keeps a partner from freely making choices (Stark, 2007). We will explore this theoretical position more in the subsequent section on frameworks, typologies, and visual tools. The important takeaway here is that the conceptual difference of defining of IPV as partner conflict—as opposed to a gendered manifestation of power and control, dominance, and coercion—leads to differential results in establishing patterns in prevalence. For example, when follow-up questions ask about the context of abuse, including whether the respondent used violence tactics as a means of self-defense, the gender symmetry disappears, with women using violence more often as self-defense (DeKeseredy & Schwartz, 1998). Findings from the most recent US national prevalence study on intimate partner and sexual violence in the general population further illustrates gendered disparities in IPV experience based on the impact, type, and severity of violence. At face value, prevalence rates appear to reflect gender symmetry: 36.4% of women and 33.6% of men reported some combination of physical violence, sexual violence, and stalking by an intimate partner (Smith et al., 2018). However, when disaggregated by type, more women (21.4%) than men (14.9%) experience severe physical violence, meaning they were hit with a fist or a hard object, kicked, hurt from hair-pulling, slammed against something, hurt by choking or suffocating, burned on purpose, or had a knife or gun used against them. More women (18.3%) than men (8.2%) experienced contact sexual violence. Furthermore, more women (10.4%) than men (2.2%) experienced stalking by an intimate partner (Smith et al., 2018). These violence types are

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noteworthy because strangulation (being choked), being hurt or threatened with a weapon, sexual violence, and stalking are risk factors for being killed by an intimate partner (Campbell, 2003). Reflecting this trend in intimate partner homicide risk factors, 45% of all US homicides between 1998 and 2008 with female victims were committed by intimate partners. In contrast, only 5% all homicides with male victims during this period were committed by intimate partners (Catalano et al., 2009). Prevalence rates and qualitative narratives alike suggest that it is important to look beyond this binary consideration of men and women, which has traditionally characterized this gender debate. The term “gender-based violence” is an umbrella term that recognizes that violence, such as IPV, is inclusive of transgender and non-­binary genders. Indeed, transgender individuals experience a greater prevalence of IPV compared to cisgender counterparts. For example, a systematic review and metaanalysis (Peitzmeier et al., 2020) found that, compared to their cisgender counterparts, transgendered individuals were 2.2 times more likely to experience physical IPV and 2.5 times more likely to experience sexual violence. Greater risks for IPV persisted when compared specifically to cisgender women (Peitzmeier et al., 2020). Using an intersectional framework, the dimensions of identity are multifaceted given the rich diversity across people and the multiple domains across which one can have relative power and privilege, oppression, and marginalization. Thus, we use gender, together with other aspects of identity, as a “conceptual frame for understanding complex social positions that influence peoples’ sources of political power and, hence, their vulnerability for IPV” (Gilfus et al., 2010, p. 246). For example, in terms of racialized identity, American Indian and Alaskan Native women have a higher prevalence of IPV compared to White women (47.5% vs. 36.4%), as do Black and African American women (45.1%) and multiracial women (56.6%; Smith et al., 2018). Thus, when we look at the full picture of frequency and severity of violence, we recognize that understanding and measuring IPV calls for a theoretical orientation that is inclusive of gender and simultaneously goes beyond gender. In the next section, we discuss commonly used frameworks and typologies that inform this theoretical orientation.

3 IPV Frameworks, Typologies, and Visual Tools Coercive Control Coercive control theory (Stark, 2007; Pitman, 2017) is one answer to the two questions posed above: What constitutes violence and what role does gender play? According to coercive control theory, IPV is more than discrete acts of violence. Discrete acts of physical violence would be hitting, pushing, kicking, and physically forced or coerced sex, such as the type of acts measured by the CTS and CTS2. Stark proposes that the problem with our current understanding and response to IPV in the United States is that it largely centers on this incident-based perspective of violence. With this incident-based perspective, researchers and helping

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professionals believe they can characterize someone’s experiences of violence by counting the total number of discrete acts of violence and ranking the types by level of severity. However, Stark, like other critics of the CTS and CTS2, asserts that this incident-based perspective neglects the full situation and context of an IPV survivor’s experience of abuse. Coercive control is a term that Stark developed to describe the full context of abuse, indicating that the foundation of IPV is power and control, wherein partners use violence to obtain and maintain control in an intimate relationship. Using tactics like degradation, humiliation, and deprivation of basic needs, for example, food, water, sleep, hygiene, these partners create “prisons” for IPV survivors in their homes. Within this framework, the abuser systematically takes away or sabotages the survivor’s freedom, e.g., freedom to work, continue their education, socialize, while the survivor continues to look for opportunities to maintain or enhance their freedom. For example, the partner may harass the survivor at work so that the survivor loses their employment, tear or burn schoolbooks, or find something objectionable about each friend or family member. Comparing these tactics, particularly the “rituals of degradation,” to those used to torture other victims of capture crimes, such as prisoners of war, prisoners, hostages, and kidnap victims, this deprivation of freedom of one partner by the other is framed as a human rights violation. These examples illustrate how counting the number of times one is hit or punched by their partner does not characterize the full nature and extent of the abuse. Dutton and Goodman (2005) also theorize about the pattern of coercive control, showing how abusive partners impose impossible rules. The penalty in the relationship for not following these “rules”—that is, a partner’s demand—is an ever-present threat of an “or else”—a credible threat for noncompliance. Given the specificity of coercive control, the implicit or explicit threat is tailored uniquely to the survivor’s situation given the abusive partner’s intimate knowledge. Box 2.2 Reflection Questions Compare the Theory of Coercive Control to the CDC definitions of IPV. What are the similarities and differences? Are the definitions complimentary? Why or why not? How do you think understanding the pattern of coercive control in a relationship could influence your approach to working with an IPV survivor and developing a safety plan?

A Visual Tool to Represent Power and Control In explicating the development and refinement of coercive control theory, Stark built upon the work of others, including Ellen Pence’s foundational work through the Domestic Abuse Intervention Project. Pence’s model, often referred to as “The Duluth Model” because of the program’s location in Duluth, Minnesota, was developed in the 1980s (Domestic Violence Intervention Programs, n.d.). Based on

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interviews with both IPV survivors and perpetrators, the Duluth Model developed a visual aid called the Power and Control Wheel, which shows that an abusive partner’s primary goal or motivation is to dominate their partner. While Pence described this motivation as stemming from the abuser’s sense of entitlement, Neil Websdale (2010) has since proposed that this stems from a deep sense of inadequacy. To achieve power and control, abusive partners use a combination of tactics, including using coercion and threats; intimidation; emotional abuse; economic abuse; children; minimizing, denying, or blaming the survivor for the abuse; isolation; and male privilege. Another visual aid, the Equality Wheel exemplifies characteristics of a healthy relationship built on equality and mutual respect. Figure 2.1 provides an image of both wheels, giving examples of the characteristics of equality and tactics of power and control. The Duluth Model still retains its relevancy, being commonly used in most survivor advocacy organizations in psychoeducation, peer support, and empowerment programs.

Fig. 2.1  Power and control and equality wheels

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Fig. 2.1 (continued)

4 Domestic Violence Typologies Michael Johnson’s Typologies explicitly draw from gender-based violence approaches to understanding IPV (Johnson, 2011). When creating this theoretical framework, Johnson was investigating empirical differences between IPV researchers from the gender-based violence perspective and those researchers from the family violence and social learning perspective (Johnson, 2017). His conclusion was straightforward: The two intellectual camps were drawing conclusions about the phenomena of IPV based on differential sources of data. Gender-based violence researchers emphasize the disparity in violent victimization and negative outcomes (e.g., injury, fear, death) of IPV for women (Reed et al., 2011). Data undergirding the gender-based violence perspective were drawn from

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women who self-identified as IPV survivors and were actively seeking services. On the other hand, social learning, or social exchange, theorists point to the violent acts carried about by both men and women as evidence that violence is learned in the home, transmitted intergenerationally, born of conflict, and perpetuated because individuals do not have the capacity to control their own violent outbursts (Johnson, 2008). Underlying data for this perspective are reports of violence found in surveys conducted with a broader community sample wherein data are collected from both parties (the dyad) who reported marital conflicts (Johnson, 2017). Essentially, Johnson argues that the theoretical dispute about gender is driven by differences in sampling and measurement. Below is a review of three of the four typologies; the fourth typology, mutual violence, will not be reviewed because it is theoretical (Johnson, 2008) and further empirical data are needed to understand couples in which both parties perpetrate acts of coercive control and violence.

Intimate Terrorism Intimate terrorism describes a relationship dynamic in which one partner uses coercive control tactics and acts of violence against the other partner to dominate the relationship (Johnson, 2008). This dynamic is the one referred to by gender-based violence scholars and in a heterosexual relationship it is typically the male partner who controls the relationship and uses acts of violence to subjugate his female partner. For IPV to qualify as intimate terrorism, four elements of power and control tactics must be present: The abuser (1) uses threats and intimidation to control their partner, (2) monitors their partner’s activities to employ control, (3) undermines their partner’s will to resist, and (4) undermines their partner’s ability to resist. Johnson explicates that physical violence within this typology of IPV is secondary to the act of undermining another’s personal freedom and liberty by creating a “relationship-­level control context” (Johnson & Leone, 2005, p. 324). Intimate terrorism may be the type of violence people most often associate with the terms domestic violence or intimate partner violence—it includes acts of physical violence but, like Stark’s coercive control model, violence, threats, intimidation, and monitoring are intermingled to gain power and control in the intimate relationship.

Violent Resistance The second typology, violent resistance, describes responsive behaviors that arise when a partner is attempting to take back control in their lives by developing coping strategies to manage the effects of intimate terrorism enacted by their abusive partner (Johnson, 2008). Johnson describes three primary coping strategies as violent resistance. First, the survivor may use violence, such as striking back during a physical attack or trying to block the assault. Second, the survivor may leave an abusive partner, although this poses significant risks for the individual including increased

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rates of stalking and intimate partner homicide (Campbell et al., 2003; McFarlane et  al., 2005). Last, the survivor may use what Johnson calls desperate acts; for example, after years of abuse and torture, the survivor commits homicide as a final attempt to escape the abuse (Johnson, 2008). Each of these acts in this context is not abuse; they are an attempt to stop the abuse and regain control over one’s life (Johnson, 2008).

Situational Couples’ Violence Johnson (2008) describes situational couples’ violence as violence that arises during conflict in a relationship. These incidents happen during communications about a couples’ most contested and tense issues. Johnson interchangeably refers to this typology as situational couples’ violence or violent conflict, but consistently emphasizes the intermittent nature of the violence and the differences between this type of violence and the violence used to gain control in intimate terrorism or to resist that control in violent resistance. Johnson asserts that situational couples’ violence provides evidence that researchers who assessed IPV from a social learning theory approach were correct in some cases—for many couples, the experience of violence is not a broad pattern of continuing abuse and attempted domination. Rather, situational couple’s violence demonstrates the maladaptive communication skills and patterns commonly found in family life when coping with stress. Violent conflicts show how failed strategies learned from one’s family of origin can be found in a broad range of couples. The inextricable difference between couples who report violent conflict and those who report intimate terrorism is the use of violence as a weapon for broad relational domination (Johnson, 2008). Nevertheless, violence that is used in the absence of overarching control has impact. Situational couples’ violence incidents are nearly gender-symmetrical, while intimate terrorism is almost exclusively carried out by men who have embodied a sense of entitlement toward their partners (Johnson, 2011). Yet, studies documenting violent conflict identify that couples are often arguing or negotiating high-stakes decisions in their relationships, such as home labor, child care, and finances, issues that intersect with social expectations and gender roles. Therefore, patriarchal culture explicitly influences each category of violence by perpetuating dangerous ideologies that erode the ability to develop healthy communication and equal support between partners. Finally, there is not yet enough research to determine whether a couple who is experiencing situational couples’ violence is at risk for escalating and shifting toward intimate terrorism. Over time, one partner may adopt strategies of general relationship control to cope with unresolved conflicts. Johnson’s typologies demonstrate that not all violence is experienced in the same way, but there is no violence that does not harm and erode the health and safety of individuals. With these theoretical frameworks and typologies in mind, we move to describing two specific types of IPV—technology-based abuse and intimate partner sexual violence—to showcase how IPV might manifest across different domains of coercive control tactics.

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5 Technology-Based Abuse Technology-based abuse is broadly defined as harmful actions that are possible because of new technologies, especially through the Internet and online life. Research literature on this topic is complex and disparate definitions have made it difficult to conclude what the phenomenon looks like among certain populations (Brown et  al., 2018; Rocha-Silva et  al., 2021). Without a clear definition it also presents challenges for carrying out intervention, practice, and policy work. However, the magnitude of literature has presented a rich description of the lived experiences and current abilities of abusers. To envision the meaning of technology-­ based abuse, the following four domains will be briefly defined: (1) monitoring, (2) cyberstalking, (3), online harassment, and (4) humiliation (Brown et al., 2018). First, online monitoring and surveillance is a common tactic among abusers wishing to create an atmosphere of control in the relationship (Douglas et al., 2019). The violation of privacy has wide-ranging actions from secretly looking through a partner’s phone, to installing stalker ware, a software that reports activity from the victim’s device. More coercive monitoring may be an explicit demand from the abusive partner, such as demanding that they share passwords and allowing access to the victim’s phone. Cyberstalking and monitoring are closely related; the most obvious differentiation is the timing of the activity in relation to the relationship, and the secrecy of stalking. However, online monitoring and controlling behaviors happening during the course of the relationship may also rise to the level of stalking based on the legal definitions in the victim’s location. Both monitoring and stalking leverage personal information for the effect of control. Online harassment includes again a spectrum of activities, including flooding a victim with calls, texts, and emails. What is crucial to this definition is the volume of interaction and the intention of disrupting the victim’s life. A most extreme example of online harassment would be doxing, or dropping documents: this is when personally identifiable information is made public (Rosenstien, 2018). Finally, humiliation tactics are rife in technology-based abuse experiences. Primarily the tactic of humiliation is possible because of social media, but cases have included other channels as well. Humiliating actions can include spreading rumors, public harassing messages, and image-based abuse (Lenhart et al., 2016). Online harassment and humiliation tactics involve an abuser weaponizing personal information to harm a victim.

6 Intimate Partner Sexual Violence: A Taxonomy of Sexual and Reproductive Control Intimate partner sexual violence (IPSV) specifically refers to types of violence that violate survivors’ sexual and reproductive health, autonomy, and decision-making, including the decision of whether to have sex at all, how to have sex, and with whom. IPSV occurs when one partner uses tactics against another to force or coerce

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unwanted sexual contact and control sexual and reproductive decision-making. When reviewing how researchers and practitioners define IPSV, there is consistency that sexual violence refers to acts that are unwanted and without the survivor’s consent. Across types of sexual violence, there is variability in the level of physical force and level of invasiveness, resulting in three main categories of IPSV: intimate partner sexual assault; intimate partner sexual coercion; and intimate partner sexual abuse. Levels of forcefulness and invasiveness can be seen as operating on a continuum rather than a category. Intimate partner sexual assault refers to IPSV tactics that are higher than other forms of IPSV in both forcefulness and invasiveness. Higher physical force includes physical violence, for example, hitting, punching, choking, or kicking, and the threats of such physical violence, including threats with a weapon or use of a weapon. Higher physical invasiveness refers to penetrative sexual activities, that is, when a penis, finger, hand, or other object is inserted into someone’s mouth, anus, or vagina. Intimate partner sexual assault also includes tactics of physical violence with attempted sexual penetration and sexual penetration when a person is unable to give consent because they are sleeping or due to the influence of drugs or alcohol, including Gamma-Hydroxybutyrate, the so-called “date-rape drug.” Intimate partner sexual coercion is like intimate partner sexual assault in that it is higher in invasiveness than other forms of IPSV, but it is lower in physical force. Instead of physical force, types of tactics to coerce unwanted sexual penetration include pressure, intimidation, and withholding of resources. For example, locking a partner out of a shared home because she did not acquiesce to demands of unwanted sex would be a type of sexual coercion, as would convincing a partner to “agree” to unwanted sexual activities through continued arguing, begging, and persuading. Sexual coercion can also look like warnings that one will have sex outside of the relationship if their sexual needs are not getting met. Intimate partner sexual abuse is lower in both forcefulness and invasiveness than other forms of IPSV. It refers to non-penetrative emotional abuse related to sex and sexuality. Such abuse tactics include derogatory sex-related name-calling and sexual insults; demeaning one’s body, focusing on sexual body parts; insulting the way one has sex or comparing sexual performance to other sexual partners. Intimate partner sexual abuse can also include requiring a partner to watch or be exposed to pornographic materials. Another key tactic of intimate partner sexual abuse is reproductive control, with such tactics as tampering with birth control, controlling condom (non)use, and refusing to compromise on family planning decisions, for example, whether to get pregnant or have an abortion. Survivors of intimate partner sexual abuse further describe their partners’ chronic infidelity, refusal to talk about sex-related decisions, and denying sex and sexual pleasure to assert sexual dominance and control. As this suite of behaviors represents, being lower in forcefulness and invasiveness does not make them less harmful, although they are less likely to be seen as criminal behavior within the current US legal system. These tactics are best understood within a coercive control framework, where these types of sexual abuse operate together in creating a web of control over the survivor’s sexual autonomy (Johnson, 2017). In the case example below, we can see how both technology-­based abuse and IPSV are incorporated in a partner’s pattern of abuse and coercive control.

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7 Case Example: Technology-Based Abuse, Intimate Partner Sexual Violence, and Coercive Control Jake and Hannah began dating two years ago; last week, after a heated argument, Jake called off the relationship. For the past several months, their communication had been precarious, and their fights had been getting worse. Once, Hannah pushed Jake away after he insulted her. After the breakup, Jake tried to get back together with Hannah, and when she told him that she had started dating someone else, he began messaging her hurtful and degrading comments. He also threatened to post nude photos and sexual videos of Hannah that he had taken “consensually” during their relationship. Hannah had only agreed to the photos after continued pressure and Jake’s insistence that “if she loved him” she would go along with his fantasy. Despite her discomfort, Hannah had acquiesced and let Jake take photos of her after a fun night of drinking with friends; after that, he became more insistent, and she felt that she had no choice because she had allowed him to do this before. Many of his messages included personal insults and a repeated accusation that Hannah was a domestic violence abuser. Jake continuously brought up the fight when Hannah pushed him, threatening to call police and to have her fired from her job as a nurse. He showed up at her work several times to “talk” when he knew that she was working. Hannah became frustrated and responded with hurtful messages, responding with a harsher tone, and resorting to insults herself. Hannah wanted to move past the breakup, but Jake continuously found new ways to reach out to her. For example, after the relationship ended, Jake took out a protection order against Hannah, describing the fight when he was pushed and showing police her insulting messages. The protection order would make it a crime for Hannah to be near him or contact him; although Jake never had the order served (so it did not take effect), he showed it to Hannah and threatened to tell her employer and her family about it if she ever contacted him again. This made Hannah very upset; she did not understand why her actions warranted a protection order when Jake was the party reaching out to her most often. She agreed not to contact him, and proceeded to block him from her email, phone, and social media accounts. They did not speak for several weeks, although Jake continued to leave comments on tagged photos of Hannah, using their mutual contacts to try and engage her after the breakup. Soon, Hannah noticed that Jake knew everything about her day. She found it creepy but did not know how it could be possible or how to prove it. Hannah’s intuition was correct; Jake had remembered her Apple ID password and used this access to remotely install spyware onto her phone. Jake began texting and messaging her from new numbers, and then he sent the intimate photos and videos she had reluctantly agreed to during the relationship. Jake’s behaviors continued to escalate. He was using technology to create a sense of omnipresence, harass and threaten his ex-girlfriend, and use her sexual experiences to shame and humiliate her all of which are forms of technology-based abuse. Although Jake never used physical violence such as hitting or pushing, after the breakup he instilled fear and control using technology, which reduced Hannah’s personal agency and ability to move past the relationship.

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Case Discussion Research on technology-based abuse is beginning to distinguish forms of online violence based on relationship context, duration, and gender (Brown et al., 2018; Dragiewicz et al., 2019; Reed et al., 2017; Rocha-Silva et al., 2021). When applying the lens of Johnson’s Typologies on technology-based abuse, patterns appear, different measures produce different conclusions, and sampling influences outcomes. Box 2.3 Applied Learning Jake and Hannah had a tumultuous breakup, and they both committed actions during the relationship (insults, pushing) that were violent without indicating intimate terrorism. The messages and online monitoring indicated harm and humiliation, qualifying as technology-based abuse. Yet, as the case progressed, do the behaviors indicate danger or intimate terrorism? Jake’s behaviors may indicate an escalation of a pattern of coercive control over Hannah, and so having proper screening and assessment tools can help social service and medical providers understand and assess survivors’ risk level. In the next section, we will explore how to assess level of risk for survivors by introducing tools for identifying lethal and near-lethal IPV. What are some actions in everyday life that can be intended, perceived, or interpreted differently? What is the difference between texting 20 times when someone is not responding and secretly logging into a private account? How would you categorize the case of Jake and Hannah using Johnson’s Typologies?

8 Using Screening and Assessment Tools in Practice with IPV Survivors Among those people who use intimate terrorism within their relationships, a small but significant number will go on to severely injure or kill their partners (Adams, 2007; Johnson, 2006). There are threatening and violent behaviors that indicate an increased danger of intimate partner homicide; these include jealous and controlling behaviors, strangulation, sexual assault, gun ownership, threats with a weapon stalking, and threats to kill (Campbell et al., 2003; Spencer & Stith, 2020). Within IPV practice, risk-informed safety planning is a strategy that provides survivors with options for avoiding abuse, minimizing the consequences of abuse, or mitigating risk in an abusive relationship (Davies & Lyon, 2014; Messing, 2019). Risk-­ informed safety planning occurs within an evidence-based practice framework (Gambrill, 2019) wherein an advocate educates a survivor about the risk in their relationship, presents multiple risk mitigation options or interventions, and

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empowers the survivor to use their self-determination to identify the strategy or strategies that will best work for their situation (Messing, 2019). Within this collaborative decision-making model, IPV risk assessment is the best-available research evidence about which IPV situations are likely to escalate. Multiple IPV risk assessments are available; the appropriateness of a risk assessment for any particular situation depends on the practice context, client characteristics, and intended outcomes (Graham et al., 2021; Messing & Thaller, 2015). The Danger Assessment (DA) (www.dangerassessment.org) was developed to predict intimate partner homicide and is intended for use by helping professionals who are implementing advocacy interventions (Campbell et al., 2003; Messing et al., 2020a). This 20-item risk assessment is ideal for use in risk-informed safety planning as it includes a calendar that helps the survivors to reflect on their experience over time, provides a comprehensive understanding of risk, and is a good starting point for education and risk mitigation strategies. There are variations of the Danger Assessment that can be used in different practice settings. The Danger Assessment-5 is a brief risk assessment that is intended to be used for screening in fast-paced environments, such as the emergency departments or other crisis situations (Messing et  al., 2017b). The Lethality Screen (Messing et  al., 2017a) and the Danger Assessment for Law Enforcement (Messing et al., 2020b) are intended to be used in collaborative interventions with criminal justice agencies to assist survivors who are at high risk of homicide in accessing services for IPV. The Danger Assessment for Immigrant Women attends to the unique risks and vulnerabilities faced by women who are immigrants to the United States (Messing et al., 2013). The DA-Circle was developed to enhance cultural appropriateness in risk assessment with Indigenous women (Bagwell-Gray et al., 2021). Other risk assessments are intended to predict IPV re-arrest or re-assault and are generally used within the criminal legal system (Graham et al., 2021). myPlan (www.myplanapp.org) is an online (mobile phone application and website) risk-informed safety planning intervention that IPV survivors can use to assess risk of homicide in their relationship (using the DA), identify their priorities, and connect to services (Eden et al., 2015; Glass et al., 2017). myPlan provides a private and safe space for users to acquire knowledge and access IPV safety strategies and resources through interactive components; Table 2.2 provides a description of each section of the intervention. Taking a gender-based violence perspective, research on myPlan has focused on women in relationships with abusive men. Evidence from five randomized controlled trials that recruited women across social and cultural contexts, both in the United States and abroad, suggests that myPlan helps survivors gain clarity about their path forward (Decker et al., 2020; Eden et al., 2015; Glass et al., 2017), safely leave an abusive partner (Glass et al., 2017), reduce symptoms of depression (Hegarty et al., 2019; Koziol-McLain et al., 2018), increase use of helpful safety strategies (Decker et al., 2020; Glass et al., 2017), and decrease IPV (or severe violence) exposure (Decker et  al., 2020; Koziol-McLain et  al., 2018). There are versions of myPlan for gender-diverse individuals and people in lesbian, gay, bisexual, transgender, queer, and others (LGBTQ+) relationships (Bloom et al., 2016) and pregnant women (Bloom et  al., 2014); adaptations are underway for

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youths, Indigenous women, and immigrant women in the United States (Bagwell-­ Gray et al., 2021; Sabri et al., 2019). Highlighting mothers’ goal of safety for their children, women with children overwhelmingly list children as their top priority within myPlan (Eden et al., 2015; Glass et al., 2017).

9 Beyond Intimate Partner Violence: The Co-occurrence of Child Abuse and Neglect This section of the chapter will move beyond couples, which we have focused on thus far, and briefly examine definitions and screening tools to identify child abuse and neglect in the context of IPV. We highlight the co-occurrence of IPV with child abuse and neglect and the impact of witnessing IPV on children. Then, we will explore tensions in cross-systems collaboration when stakeholders’ definitions and measurement of IPV conflict. As we consider barriers to collaboration between IPV and Child Welfare systems, reflect on the question earlier in the chapter: What constitutes violence? For children, does witnessing abuse in the home between parents count as violence against them? What is “failure to protect” and why is this way of thinking problematic? Using a strengths-based perspective, we will provide some information on interventions and approaches to build collaborations with between IPV and child welfare to enhance resilience for children survivors of witnessing IPV and their caregivers. We will end with a case study illustrating how myPlan, a safety planning tool that incorporates the DA, can be used by child welfare workers to help safety plan with parents involved in child welfare.

I dentification, Screening, and Assessment of Child Abuse and Neglect In 2019, approximately 4.4 million (4,378,000) referrals alleging child maltreatment were made to child protective services (CPS) agency hotlines or intake units in the United States. Among these referrals, 2.4 million were screened-in as appropriate for further CPS action (US Department of Health & Human Services, 2020). Screened-in referrals are investigated by a CPS worker to determine whether the alleged maltreatment made in the referral can be substantiated. Of the 4.4 million referrals, 656,000 (rounded) screened-in referrals were confirmed (i.e., substantiated) as victims of child abuse and neglect following the CPS investigation (Health & Human Services, 2021). The most common type of child maltreatment suffered by children in 2019 was neglect (74.9%), followed by physical (17.5%) and sexual (9.3%) abuse. CPS mandates screened-in families with significant child safety concerns to receive services. Services may be in-home support services that aim to preserve the

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Table 2.2  The myPlan Intervention 3.0 Primary section Learn

Secondary content section User information gathered Information delivered Myth or Fact Information delivered True/ Describes common misperceptions False quiz style about domestic violence and reframes these victim-blaming statements to redirect attention toward the abuse perpetrator Healthy N/A Provides eight different components Relationships of healthy relationships Safety Resources Uses Zip code to identify Local domestic violence program, Plan local programs relevant national websites, and population/culturally based services in the area Strategies Selects certain strategies Describes methods for deescalating based on prior answers violence, setting up support networks, given in the Assess section leaving with decreased risk, and protecting children during violent incidents Assess My Info Demographic Assessments and safety strategies characteristics gathered to tailored to the individual’s tailor safety plan demographic characteristics information and other relevant pathways My The Composite Abuse Scale Identifies whether an intimate Relationship relationship is healthy, somewhat Health unhealthy, or unhealthy My Safety Danger Assessment Identify the most dangerous abusive behaviors; immediate feedback on homicide risk My Priorities Safety Decision Aid Presents information about priorities using percentages for each of the five categories Get Help Chat icon top N/A Link to Chat right corner Link to Call

family unit or out-of-home services (e.g., foster care or reunification services). Alternatively, suppose the screened-in case is determined substantiated but having only low-to-moderate safety concerns. In that case, CPS might apply a differential response approach providing families with services in a voluntary fashion (i.e., preventative services). Thus, it is possible to have a substantiated case without having the case open for services. In 2019, CPS only mandated that 27.7% of families investigated by CPS receive post-investigative services (Health & Human Services, 2021). During this investigative period, in addition to assessing for child maltreatment, CPS workers assess for child and caregiver characteristics associated with increased child maltreatment (e.g., substance use, domestic violence/IPV, prior CPS involvement, prior arrest, mental illness). The CPS worker typically makes this assessment using a standardized tool (Cuccaro-Alamin et al., 2017). The most widely used CPS

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risk assessment tools are the Structured Decision Making model, the ACTION for Child Protection and National Resource Center for Child Protective Services model, and the Signs of Safety model (Harbert & Tucker-Tatlow, 2012). Among the 38 states reporting risk factors through the 2019 National Child Abuse and Neglect Data System,1 the most prevalent caregiver risk factors reported were drug abuse (29.4%) and domestic violence/IPV (28.8%) (Health & Human Services, 2021).

Co-occurring IPV and Child Maltreatment IPV places children at increased risk of child maltreatment (Appel & Holden, 1998; Edleson, 1999; Herrenkohl et al., 2008; Rebbe et al., 2021) and has negative implications for children’s health and well-being (for reviews, see Kitzmann et al., 2003; Li, 2019; Wolfe et al., 2003). Co-occurring IPV and child maltreatment rates range between 30 and 60% (Appel & Holden, 1998; Edleson, 1999; Herrenkohl et  al., 2008). Child exposure to IPV is associated with several emotional and behavioral problems, such as internalizing and externalizing problems, post-traumatic stress, IPV perpetration, depression, and substance use (Chan & Yeung, 2009; Chemtob & Carlson, 2004; Evans et al., 2008; Geyer & Ogbonnaya, 2017; Graham-Bermann et  al., 2012; Harper et  al., 2018; Kitzmann et  al., 2003; Kulkarni et  al., 2020; Thibodeau et al., 2017; Vu et al., 2016; Wolfe et al., 2003). An estimated 15.5 million children live in households with IPV; 7 million of these children are in families with severe IPV (McDonald et al., 2007). Given the high risk of co-occurring IPV and child maltreatment and associated emotional and behavioral health problems, many children exposed to IPV become involved with CPS. Using data from the National Survey of Child and Adolescent Well-Being,2 Hazen et al. (2004) found that 45% of permanent female caregivers reported experiencing at least one IPV incident in their lifetimes and that 33% of these incidents were severe (e.g., being beaten up, strangled, or beaten with a weapon). Cumulative exposures to IPV increase children’s risk of poor psychosocial outcomes (Vu et al., 2016) and children’s psychosocial adjustment outcomes are worse when IPV co-­ occurs with child maltreatment (Kitzmann et al., 2003; Wolfe et al., 2003). Moreover, the adverse outcomes associated with childhood exposure to IPV may be long-­ lasting and, therefore, subsequently affect the children of those exposed to IPV as a child (Li et al., 2019; Lünnemann et al., 2019). The detrimental effects of childhood exposure to IPV are highly problematic, particularly considering that many children are affected by IPV.

 National Child Abuse and Neglect Data System is a federally sponsored effort that collects and analyzes annual data on child abuse and neglect. The data are submitted voluntarily by the 50 states, the District of Columbia, and the Commonwealth of Puerto Rico. 2  A longitudinal nationally representative sample of children aged birth to 15 years involved with CPS, with baseline data collected between 1999 and 2000. 1

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10 Helping Child Welfare Workers Identify IPV Despite the high rates of IPV in their caseloads, CPS workers often struggle with the IPV assessment and referral processes (Casanueva et al., 2014; Kohl et al., 2005; Mennicke et al., 2019; MacPherson, 2010; Moles, 2008). Comparing IPV and caseworker identified IPV using National Survey of Child and Adolescent Well-being data, Kohl et al. (2005) found that 31% of CPS-involved caregivers reported an IPV experience in the past year and that CPS caseworkers identified IPV in only 12% of these caregivers’ CPS cases. This finding indicates that child welfare workers might under-identify IPV in many of their cases (Casanueva et al., 2014; Kohl et al., 2005). Under-identification of IPV means CPS misses opportunities to provide IPV services to families in need. Even when identified, CPS workers fail to refer IPV-­ affected clients to IPV services (Bank et  al., 2018; Lawson, 2019; Rebbe et  al., 2021; Wu et  al., 2021). For instance, a recent population-based study using California administrative records for 305,867 children under age 5 years reported to CPS between 2010 and 2014 and having no history of foster care placement found that, although cases involving IPV have a greater risk of substantiation than cases without IPV, substantiated cases involving IPV were not more likely to be open for mandated services (Rebbe et al., 2021).

Barriers to Collaboration Between IPV and CPS Agencies The high prevalence of co-occurring IPV and child maltreatment indicates some overlap between clients receiving services from IPV and CPS agencies. Yet, the two agencies have not historically worked well together and continue to struggle with collaboration (Fusco, 2013; Goodman et al., 2020; Langenderfer-Magruder et al., 2019; MacPherson, 2010; Mennicke et al., 2019; Moles, 2008). The Nicholson v. Scoppetta federal court case decision banning CPS’ ability to remove children based solely on the premise of parents’ IPV victimization (Dunlop, 2004) largely influenced policies regarding how CPS should handle cases with alleged IPV. This case also shed light on the complexities involving child exposure to IPV and the longstanding tension between IPV and CPS agencies, despite both agencies’ shared goal of keeping families safe. The IPV and child welfare literature (Coulter & Mercado-Crespo, 2015; Fusco, 2013; Langenderfer-Magruder et  al., 2019; MacPherson, 2010; Mennicke et al., 2019; Moles, 2008) highlights the following factors as reasons for this tension: (1) conflicting philosophies, (2) different mandates, (3) lack of communication, and (4) limited training. We discuss each of these factors in the following sections.

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Conflicting Philosophies CPS and IPV advocates have traditionally differed in how they view the mother’s role in IPV. Although the primary goal for both CPS and IPV advocates is safety, CPS workers typically place greater emphasis on child safety and IPV workers prioritize women’s safety (MacPherson, 2010). Therefore, workers from the two systems have traditionally employed different strategies to achieve safety. CPS workers have historically held IPV survivors legally accountable for child exposure to IPV by charging survivors with “failure to protect” their children and, in some cases, removing children from their homes (MacPherson, 2010). Literature suggests this is still happening even after the Nicholson v. Scoppetta case set a precedent that it should not. CPS workers may suggest counseling interventions or request that the non-offending parent end the relationship with the abuser as a form of IPV intervention (MacPherson, 2010). IPV advocates have accused CPS workers of “victim-­ blaming” or putting all responsibility on the IPV survivor without holding the IPV perpetrator accountable (Douglas & Walsh, 2010). Additionally, IPV advocates consider the approaches used by child welfare advocates as insensitive to the challenges involved with women leaving abusive relationships (MacPherson, 2010; Moles, 2008). Different from child welfare workers, IPV advocates are more likely to work from feminist and empowerment philosophical frameworks. They view IPV as the result of patriarchal power and control and other forms of gender-based oppression (Goodman et al., 2020). As such, approaches to safety planning used by IPV advocates typically include interventions that aim to shift gender power, providing women with greater autonomy (e.g., shelter, education, legal advocacy). This perspective holds that empowering women will reduce their risk of IPV and, thereby, increase their and their children’s safety and well-being (Sullivan, 2018). The disparate focus between IPV and CPS agencies has made IPV advocates reluctant to work with CPS agencies due to fear that the strategies used by CPS could further harm IPV survivors (Carlson et al., 2020). Different Mandates and Organizations CPS agencies are government agencies working with clients mainly receiving involuntary services, whereas IPV agencies are typically community-based non-profit agencies working with clients voluntarily seeking services (Moles, 2008). The involuntary nature of CPS services represents the antithesis of what IPV agencies strive for, creating a power differential similar to the experience between a victim and her abuser (Carlson et  al., 2020). Nonetheless, as mandated reporters, IPV advocates are legally obligated to report any suspicion of child maltreatment. Therefore, IPV advocates working with children sometimes find themselves also working with CPS agencies.

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Some IPV advocates working with children report feeling hesitant to report suspected child abuse and neglect due to uncertainty about whether exposure to IPV constitutes a form of child maltreatment (McTavish et  al., 2017). Additionally, many women seek IPV services to protect their children (Murray et al., 2015). Thus, in these situations, it is difficult to report child exposure to IPV as a form of child abuse or neglect because the purpose of seeking IPV services was to help maintain safety for the child victim (Carlson et al., 2020). In their study with 142 IPV shelter advocates from a midwestern state, Carlson et al. (2019) found that the better the advocate’s perceived organizational relationship with CPS, the more likely they were to agree with the need to report child’s exposure to IPV. Another study involving IPV advocates, child welfare workers, and law enforcement (N = 140) revealed that about one-third of participants believed reporting suspected child maltreatment to CPS “often” damaged the relationship between IPV survivors and IPV advocates (Coulter & Mercado-Crespo, 2015). Further, 44% of study participants felt that reporting child maltreatment discouraged IPV survivors from seeking help “half of the time.” Regardless, most participants saw the need to report child maltreatment, believing that doing so protects children “always” (41%) or “often” (30%). Thus, there is agreement among those working with children that IPV negatively impacts child welfare, despite disagreements on how best to handle this problem. Communication Issues Poor communication between CPS and IPV agencies also creates barriers to collaboration (Langenderfer-Magruder et al., 2019; Mennicke et al., 2019). In a qualitative study in Florida exploring 493 child welfare workers’ short answers from an open-ended survey with questions regarding challenges on cases involving IPV, participants commonly cited communication as a key challenge. They explained that troubles arise in information gathering and sharing when clients share different types of information with workers from the different sectors. It becomes even more difficult for child welfare workers to perform their roles when confidentiality constraints are in place that prevent IPV advocates from sharing client information (Langenderfer-Magruder et al., 2019; MacPherson, 2010). Additionally, maintaining open communication is difficult due to time constraints (e.g., high workloads) and conflicting schedules (Langenderfer-Magruder et al., 2019). Limited Training Researchers have found that child welfare workers’ limited IPV training impedes their ability to adequately serve families experiencing IPV (Coulter & Mercado-­ Crespo, 2015; Fusco, 2013; Mennicke et al., 2019). In their study exploring IPV service providers’ perceptions of child welfare workers’ process with IPV cases, Mennicke et  al. (2019) found that IPV service providers perceived child welfare

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workers as lacking competence, mainly as it related to IPV assessment. This lack of competence made IPV service providers feel frustrated when working with child welfare workers. They partially attributed the lack of competence to child welfare workers’ lack of IPV training (Mennicke et al., 2019). From the perspective of child welfare workers, a qualitative study with 19 child welfare caseworkers found a common theme was feelings of being ill-prepared to work with cases of co-occurring IPV and child maltreatment. This fear streamed from having limited training and education on IPV (Fusco, 2013). Findings from these studies reflect results from a recent study showing more than half of IPV service providers reported receiving 10 hours or more of training on the co-occurrence of IPV and child maltreatment compared to only 37.2% and 19.7% of child protective investigators and child welfare service providers, respectively (Coulter & Mercado-Crespo, 2015). However, there is also evidence that sometimes child welfare workers perceive IPV advocates as unable to understand child welfare (Langenderfer-Magruder et al., 2019).

Moving Forward: Opportunities for Improved Collaboration Barriers to collaboration present multiple opportunities for improvement. The child welfare field has worked extensively to improve CPS caseworkers’ skills and strategies for addressing IPV. Examples of interventions used by CPS to address IPV include using specialized IPV assessment tools and conducting inter-agency trainings with IPV agencies (Aron & Olson, 1997; Banks et  al., 2009; Coulter & Mercado-Crespo, 2015; Magen et al., 2001; Rivers et al., 2007; Rosewater, 2008). In addition, some CPS agencies have created specialized positions for IPV specialists whose primary functions may include one or more of the following: Client Support and Advocacy, Systems Change, and/or Batterer’s Compliance (Rosewater, 2008). Some of these efforts have been effective (e.g., see Banks et al., 2008). More recently, a novel approach that centers both the adult survivor and the child survivor—recognizing that their well-being and needs are inextricably linked—can bring the child welfare and domestic violence systems together with greater collaboration (Quality Improvement Center for Domestic Violence and Child Welfare, 2018). In addition to increased training and collaboration, the myPlan intervention presents an opportunity for child welfare professionals serving clients who have experienced IPV to screen and intervene.

11 Case Study: Co-occurring Child Maltreatment and IPV Kaeo and Michael have been married for seven years and have three children in common. They began dating while they were both undergraduate students at a US university. Kaeo, who is from Thailand, was studying under a student visa. Upon graduation, Kaeo enrolled in graduate school and was excited about pursuing her

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dream job in public health. However, after getting married, Michael convinced Kaeo to defer her schooling so they could spend more time together. Michael, who is a US citizen, reassured her that he would petition for her to become a US citizen by marriage. However, over time, he continually made excuses for why he did not submit the paperwork, consistently saying it was his next priority. He accused her of being too needy and self-centered when she brought it up. In this way, Kaeo became dependent on Michael for her citizenship status. She was no longer enrolled in school, ineligible for employment, and began living in fear of deportation. Michael was always controlling and jealous, but when Kaeo was pregnant, his behaviors escalated. He expected Kaeo to be the “perfect wife,” which to him meant doing all the domestic chores (e.g., cleaning, cooking) and being available for whatever Michael wanted (e.g., going to a work function, spending time at home, engaging in sexual activity). He began to make comments that belittled and humiliated Kaeo in front of family and friends. Some of Michael’s insults were specific to “illegal immigrants” in the United States. These insults were extremely harmful to Kaeo, who was afraid and embarrassed to share her situation with anyone. Michael told her that the police will not believe her since she has a strong accent and overstayed her student visa. When their second child was born, Michael’s behavior worsened. Now, in addition to exhibiting a need to control Kaeo, he had become obsessive and sexually jealous. He often accused Kaeo of having affairs, flirting with other men, and demanded sexual activity to prove loyalty. Michael lost his job due to recent economic challenges; then he bought a handgun against Kaeo’s wishes. He kept the gun by the bed, refusing to store it safely (i.e., in a safe, unloaded, and separate from the bullets). In private he yelled insults at Kaeo, used his body to block her in rooms or back her into the wall, and made threats about killing her while displaying or cleaning his gun; this created an environment of intimidation and fear. During one of their arguments, the neighbors called the police. Since their children were home at the time of the incident, the police notified the local division of child protective services (CPS). A case was opened for investigation and the outcome was a required parenting course for both Kaeo and Michael. Not only had the abuse worsened, but also now she grappled with the possibility of losing her children. Because Kaeo’s family was in Thailand, Kaeo found herself relying on her church community for support more and more. This was the only place she could speak Thai and be around other Thai and Lao individuals. Her community understood the importance of family and respected her wishes not to divorce her husband. After a fight became physical, in which Michael pushed Kaeo to the ground and kicked her, Kaeo took the children and went to stay with her friend from her church. She was flooded with text messages and calls. Michael sent a picture of her sitting with her friend during a church dinner, indicating that he had followed her. Next, he sent a picture of the handgun and a message insinuating he would kill her if she left him. Kaeo decided to comply with Michael’s wishes and return home: She loved him and did not want her children to be without a father, and she was afraid for herself, her children, and her friends from the church who had taken her in during this time.

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Soon after, Kaeo’s child welfare worker found myPlan, an online tool that guided their work together as Kaeo assessed her relationship, developed a plan to increase her safety, and considered the risk to herself and her children. The myPlan app provided tailored safety strategies about her immigration paperwork, using a safe word with her church friends, and safely removing the handgun from the home and turning it over to police. Rather than using these suggestions as a warning to Kaeo about removing her children, her caseworker partnered with Kaeo in a survivor-led safety planning process, in which myPlan helped reduce Kaeo’s uncertainty about next steps and weigh her personal priorities. The caseworker acknowledged the complexities of living in a violent relationship, connected Kaeo with resources in the community, and supported her in taking actions that were empowering. Ultimately, myPlan helped Kaeo understand risk of IPV on child health and well-being. It also bridged gaps between CPS and IPV agencies, which began working together to ensure her safety. Based on information embedded in myPlan on technology safety (https://www.techsafety.org/resources-­survivors), Kaeo used her laptop to store screen shots of the messages that Michael had sent her and took the extra precaution of encrypting the file and updated all her passwords. Michael began threatening to turn her into the immigration and customs enforcement (ICE). Kaeo and her CPS caseworker checked with a legal advocate at the local domestic violence shelter and learned of a Violence Against Women Act (VAWA) program that could protect her from deportation.

12 Summary IPV is a prevailing type of family violence. This chapter provides an overview of common definitions and typologies to understand IPV, measurement instruments and screening tools to identify and assess the severity of IPV, and safety strategies to support IPV survivors. Because IPV impacts the whole family system, this chapter also covers how IPV impacts child survivors and provides suggestions for improving the response to IPV within the child welfare system in the United States. Cross-sector collaboration can help community partners reach a shared understanding of the definitions and measures of IPV and streamline their response to better serve families affected by IPV.

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Center on Violence Against Women, Applied Research Forum. Retrieved from VAW.net web archives: https://web.archive.org/web/20130504013706/http://www.vawnet.org/Assoc_Files_ VAWnet/AR_ctscrit.pdf Domestic Violence Intervention Programs [DAIP]. (n.d.). About Us [webpage]. Retrieved from https://www.theduluthmodel.org/about-­us/ Douglas, H., & Walsh, T. (2010). Mothers, domestic violence, and child protection. Violence Against Women, 16(5), 489–508. https://doi.org/10.1177/1077801210365887 Douglas, H., Harris, B. A., & Dragiewicz, M. (2019). Technology-facilitated domestic and family violence: Women’s experiences. The British Journal of Criminology, 59(3), 551–570. Dragiewicz, M., Woodlock, D., Harris, B., & Reid, C. (2019). Technology-facilitated coercive control. In W. S. DeKeseredy, C. M. Rennison, & A. K. Hall-Sanchez (Eds.), The Routledge international handbook of violence studies (pp. 244–253). Routledge. Dunlop, J.  A. (2004). Judging Nicholson: An assessment of Nicholson v. Scoppetta. Denver University Law Review, 82, 671–690. Dutton, M.  A., & Goodman, L.  A. (2005). Coercion in intimate partner violence: Toward a new conceptualization. Sex Roles: A Journal of Research, 52(11–12), 743–756. https://doi. org/10.1007/s11199-­005-­4196-­6 Eden, K.B., Perrin, N.A., Hanson, G., Messing, J.T., Bloom, T., Campbell, J., Gielen, A., Clough, A., Barnes-Hoyt, J., Glass, N. (2015). The immediate impact of an internet safety decision aid on abused women’s decisional conflict about staying safe: Findings from the IRIS randomized controlled trial. American Journal of Preventive Medicine, 48(4), 372–383. Evans, S. E., Davies, C., & DiLillo, D. (2008). Exposure to domestic violence: A meta-analysis of child and adolescent outcomes. Aggression and Violent Behavior, 13(2), 131–140. https://doi. org/10.1016/j.avb.2008.02.005 Fusco, R. A. (2013). "It’s hard enough to deal with all the abuse issues": Child welfare workers’ experiences with intimate partner violence on their caseloads. Children and Youth Services Review, 35(12), 1946–1953. https://doi.org/10.1016/j.childyouth.2013.09.020 Gambrill, E. (2019). Critical thinking and the process of evidence-based practice. Oxford University Press. Geyer, C., & Ogbonnaya, I. N. (2017). The relationship between maternal domestic violence and infant and toddlers’ emotional regulation: Highlighting the need for preventive services. Journal of Interpersonal Violence, 36(3–4), 1029–1048. https://doi.org/10.1177/0886260517739891 Gilfus, M. E., Trabold, N., O’Brien, P., & Fleck-Henderson, A. (2010). Gender and intimate partner violence: Evaluating the evidence. Journal of Social Work Education, 46(2), 245–263. https://doi.org/10.5175/JSWE.2010.200900019 Glass, N. E., Perrin, N. A., Hanson, G. C., Bloom, T. L., Messing, J. T., Clough, A. S., et al. (2017). The longitudinal impact of an internet safety decision aid for abused women. American Journal of Preventive Medicine, 52(5), 606. https://doi.org/10.1016/j.amepre.2016.12.014 Goodman, L. A., Fauci, J. E., Hailes, H. P., & Gonzalez, L. (2020). Power with and power over: How domestic violence advocates manage their roles as mandated reporters. Journal of Family Violence, 35(3), 225–239. https://doi.org/10.1007/s10896-­019-­00040-­8 Graham, L.M., Sahay, K.M., Rizo, C.F., Messing, J.T., Macy, R.J. (2021). The validity and reliability of available intimate partner homicide and re-assault risk assessment tools: A systematic review. Trauma, Violence, & Abuse, 22(1) 18–40. Graham-Bermann, S.  A., Castor, L.  E., Miller, L.  E., & Howell, K.  H. (2012). The impact of intimate partner violence and additional traumatic events on trauma symptoms and PTSD in preschool-aged children. Journal of Traumatic Stress, 25, 393–400. https://doi.org/10.1002/ jts.21724 Harbert, A., & Tucker-Tatlow, J. (2012). Review of child welfare risk assessments. Southern Area Consortium of Human Services. https://theacademy.sdsu.edu/wp-­content/uploads/2015/02/ SACHS_Risk_Assessment_Report_and_Appendices_11_2012.pdf Harper, B., Nwabuzor Ogbonnaya, I., & McCullough, K. C. (2018). The effect of intimate partner violence on the psychosocial development of toddlers. Journal of Interpersonal Violence, 33(16), 2512–2536. https://doi.org/10.1177/0886260516628286

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Chapter 3

Gender Issues in Intimate Partner and Family Violence Research Iris F. McMillan, Grace E. Schroeder, Jan T. Mooney, and Jennifer Langhinrichsen-Rohling

Family violence is a serious social problem and public health concern (Chan et al., 2021), with families traditionally defined as a social group consisting of two opposite-­sex, married adult household members and their biological offspring (i.e., the Standard North American Family; Smith, 1993). However, across the last few decades, family structures in the United States have undergone dramatic changes. “Traditional” American nuclear family structures have diversified in terms of parental gender identity, number of parents in the home, parental relationship status, number of children in the home and their relationships to each parent (step, adopted, surrogate), and children’s gender identity. As a result, many US families no longer fit the traditional definition of the Standard North American family. Similar transformations have occurred with the definition of family violence to include a larger array of family members (biological, step, adopted, siblings, grandparents, extended family), family gender and sexual orientation configurations, and types of violence (physical, sexual, psychological, stalking/surveillance, and cyber abuse, intimate partner violence [IPV], sibling and elder abuse). In the current chapter, we argue that family processes related to violence and aggression are incompletely understood when only studied with cisgender, heterosexual, middle class, Eurocentric model of family as a reference point (Few-Demo & Allen, 2020). An enhanced understanding of family violence will occur when we expand the lens to include a broader array of types of violence occurring across an array of gender and sex diverse family structures. To address this argument, we I. F. McMillan · G. E. Schroeder · J. T. Mooney University of North Carolina at Charlotte, Health Psychology PhD Program, Charlotte, NC, USA J. Langhinrichsen-Rohling (*) University of North Carolina at Charlotte, Department of Psychological Science, Charlotte, NC, USA e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 P. Sturmey (ed.), Violence in Families, Advances in Preventing and Treating Violence and Aggression, https://doi.org/10.1007/978-3-031-31549-7_3

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focus on intimate partner violence (IPV). IPV is one of the most frequently studied forms of family violence, and it has been largely conceptualized from a heteronormative perspective (i.e., using heterosexuality as the default standard, typically accompanied by an emphasis on male–female power differences in society and the reification of binary and mutually exclusive gender roles; American Psychological Association, n.d.). This understanding of IPV has become widely known as the gender paradigm, which rests on the assumption that most violence is perpetrated by men against women and children (e.g., Dutton, 1994). We argue that gender-­ binary explanations of IPV provide little room for the heterogeneity and variability in lived family violence experiences and for needed innovation in prevention and intervention efforts. To fully understand IPV specifically and family violence more generally, the social structures surrounding gender, sex, and sexual orientation and their relations to violence perpetration must also be considered. Gender is commonly understood as the endorsement of attitudes and the enactment of behavioral aspects that are associated with being either biologically male or female or one’s sex (i.e., socially constructed). Gender roles and behaviors are thought to be learned and reinforced within the family of origin and subsequently enacted in romantic relationships, thus, connecting one generation to another. Understanding IPV requires acknowledgment of the evolving and dynamic nature of gender and gender roles in romantic and family relationships (Thomeer et al., 2020) and in society. For example, the substantial occurrence of IPV in same-sex relationships has been revolutionary in challenging the gender paradigm, drawing attention to the assumptions and behaviors associated with gender variables rather than framing the gender binary as the main predictor of perpetration (Cannon, 2015). A note on language  We would like to explicitly acknowledge our decision to maintain the cisnormative language present in much of the existing literature, to allow comparisons and draw distinctions across studies. However, we note that violence researchers have tended to use the terms “sex” and “gender” interchangeably, with “gender” widely conceptualized and measured as a fixed binary individual characteristic (i.e., male/female) rather than a dynamic social construct (De Coster & Heimer, 2021). This conflation of terms prevents researchers from disentangling gender (i.e., a set of characteristics, behaviors, or traits that are associated with a certain biological sex that can develop and evolve across time and through interactions with culture) and sex (i.e., a label referring to a specific combination of chromosomes, hormones, primary and secondary sex characteristics). It also perpetuates cisnormativity (i.e., presumed congruence between sex assigned at birth and gender identity and expression). Second, we will refer to romantic relationships in which both partners have the same sex assigned at birth as same-sex relationships. However, this decision fails to reflect the diversity of sexual and gender identities within relationships. For example, female-born individuals in same-sex relationships may not identify as lesbian; instead, they may self-identify in other ways (e.g., bisexual, pansexual, queer). Finally, we use the term “queer family violence” as a descriptor for violence occurring in structures within which family members identify along the broad spectrum of romantic and/or sexual attractions (e.g., being

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attracted to people of many gender identities and expressions), gender identities, and/or gender expression (e.g., crossdresser, non-binary, genderqueer, Two-Spirit, third gender, gender fluid, intersex). While we are using these labels intentionally to refer to current research, we acknowledge that these labels may also unintentionally erase the expansive and fluid nature of sexual and gender identities.

1 Family Violence: A Prevailing Phenomenon Family violence is an umbrella term commonly used to describe the various forms of interpersonal violence and aggression that can occur within the family context, including child maltreatment, sibling violence, intergenerational elder abuse, and IPV. Researchers have focused on describing and understanding various forms of family violence, generally emphasizing each one’s prevalence and associated risk and protective factors. It is estimated that one in four children are exposed to at least one form of family violence during their lifetime (Hamby et al., 2011). Additionally, different forms of family violence frequently co-occur; poly-victimization (i.e., co-­ occurrence of multiple types of violence) is commonplace (Bradel-Warlick & Rosenbaum, 2020). Moreover, given the array of violence types subsumed under the term family violence and the numerous assessment strategies and methodologies utilized, obtained prevalence rates vary considerably. To illustrate, three types of family violence are briefly described with sex differences in prevalence rates highlighted.

Child Maltreatment Child maltreatment is blanket term encompassing all forms of child abuse and neglect, including sexual, physical, and psychological abuse. Estimates suggest 87.5% of childhood sexual abuse occurs inside the child’s home with over one-third of victims being abused multiple times a year. Sex specificity is noted: most child sexual abuse involves a male perpetrator and a female victim (Assink et al., 2019). Additionally, girls are more likely than boys to experience prolonged and penetrative sexual abuse (Maikovich-Fong & Jaffee, 2010). Consistent with these rates, sexual abuse is often depicted as a uniformly gendered phenomenon affecting only female victims. Unfortunately, this leaves male victims of child sexual abuse largely invisible. With regard to child physical abuse, approximately 23% of children experience this (Stoltenborgh et al., 2015), with similar prevalence rates for boys and girls (Lee & Chen, 2017). Child emotional abuse is also common, with estimates indicating that 19–25% of US children are victims (Burns et al., 2010). Girls may experience more familial psychological abuse than boys (Sunley et al., 2020).

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Sibling Abuse and Violence Sibling violence, also known as sibling maltreatment or sibling abuse, is perhaps the least studied type of family violence. There is a lack of consensus on its operational definition, including how to distinguish sibling violence from sibling rivalry and roughhousing. Intention is an important component of sibling violence as violent behaviors are perpetrated to achieve dominance and inflict harm rather than to obtain resources such as parental attention or as play (Morrill & Bachman, 2013). Like child maltreatment, sibling abuse has different forms of expression: sexual, physical, and emotional abuse. Physical violence among siblings is common; between 40 and 80% of siblings are victims, perpetrators, or both (Button & Gealt, 2010). Sibling emotional abuse is also common as more than 80% of siblings report being either a victim or perpetrator (Mackey et  al., 2010). While sibling sexual abuse is less common overall, it constitutes the most typical configuration of childhood sexual abuse, with an incidence rate three to five times greater than by a male parent/caregiver. Older male siblings are the most common perpetrators (Tener et  al., 2020). Unlike sexual abuse among siblings, which is typically perpetrated from a male sibling to a female sibling, there appear to be no significant sex differences in rates of perpetration of physical and psychological sibling abuse (Button & Gealt, 2010; Mackey et al., 2010).

Intimate Partner Violence According to the Centers for Disease Control and Prevention (CDC), IPV consists of physical violence, sexual violence, stalking, and/or psychological–emotional harm caused by a current or former intimate partner (or spouse; Centers for Disease Control and Prevention [CDC], 2021). This form of violence is not limited to the family context but instead presents across an array of romantic relationships with differing levels of commitment (marriage, cohabitating, dating). The term interparental violence denotes the occurrence of IPV between two, often presumed to be heterosexual, romantically involved adults; many are pictured as cohabitating in a household with children. Consistent with this view, longitudinal research with pregnant women suggests that IPV often persists, becoming interparental violence after the birth of a child, with 83% of women who experienced IPV victimization during pregnancy also reporting one or more experiences of interparental violence across their children’s lives (Figge et al., 2021). Exposure to interparental IPV is associated with child adjustment problems (Vu et al., 2016). Thus, some states consider child exposure to interparental violence as a type of child maltreatment (Victor et  al., 2019), making IPV a leading contributor to child protective services involvement as well as a public health concern.

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2 The Gender Paradigm: Challenging the Gendered Explanation of Intimate Partner Violence Earliest conceptualizations of IPV such as those advanced through traditional feminist models (e.g., the Duluth Model; Pence & Paymar, 1993) have been of great historical and clinical importance. These models have de-normalized, problematized, and highlighted male-perpetrated domestic violence and resulted in public awareness of male-to-female perpetrated IPV. Feminist efforts also led to the adoption of groundbreaking legislation to protect women, support battered women’s shelters, and criminalize violent male behavior against their female partners (e.g., the Violence Against Women Act). However, as an unintended consequence, these early conceptualizations of IPV supported a stereotype of intimate partner violence that did not distinguish between gender and biological sex and did not consider the array of sexual orientations that could be located within violent intimate relationships. IPV was thus initially understood as a heterosexual phenomenon, rooted in gender-based inequities, and primarily, if not exclusively, perpetrated by males. Of note, the gender paradigm also led to a quick differentiation between male-­ perpetrated IPV and female-perpetrated IPV once the presence of female-­perpetrated IPV was acknowledged. Male-perpetrated IPV was framed as an intentional act, perpetrated with the intention to dominate or control, for which the male perpetrator should be held solely accountable. In contrast, female-perpetrated IPV was typically considered the product of situational or contextual factors (i.e., reactive, in self-defense) and therefore, not the sole responsibility of the female perpetrator (Dutton et al., 2009). This early unilateral focus on male-perpetrated IPV in heterosexual romantic relationships has been further reified through the ongoing use of terminologies such as gender-based violence (i.e., acts of verbal or physical force, coercion or other harmful acts directed at women and girls with the goal of perpetuating female subordination; Heise et al., 2002). Our concern is that this view discounts the heterogeneity of IPV perpetration and victimization/survivorship across the gender binary. It also, likely unintentionally, leads to invisibility of certain victims as a result of its non-inclusivity. Unfortunately, it also prematurely solidified the IPV prevention and intervention fields around a single explanatory narrative that centered the role of male privilege in perpetration, in spite of an obvious need for these efforts to increase their efficacy and to protect and support additional populations at risk for harm. Finally, original iterations of the power and control theory and the gender paradigm have also failed to consider the interaction of multiple social identities in the creation of situations of power, privilege, and oppression; this oversight has also slowed the field’s advancement and inclusivity. However, much of the recent IPV literature has been challenging the whole-scale adoption of the traditional gender paradigm and interesting expansions of theory are taking place. Five main challenges are described in the current chapter: (1) the growing literature detailing the not-rare occurrence and consequences of female-­ perpetrated IPV; (2) evidence challenging patriarchy as the sole cause of IPV; (3) the considerable prevalence of bi-directional IPV, which raises the need to consider

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family and relationship dynamics as risk factors; (4) the prevalence of IPV in lesbian, gay, bisexual, transgender, queer, two-spirit, and others (LGBTQ2+) relationships; and (5) an expanded understanding of sex and gender in the context of nature and nurture debates related to the perpetration of violence and aggression. We conclude the chapter with an integration of these findings and their implications for the IPV and family violence fields.

Female Perpetrators and Male Survivors Exist The first gender-related challenge came from results substantiating that females perpetrate acts of violence at rates equal to or even greater than males. For example, the results of meta-analysis suggest that one in four females and one in five males perpetrate physical violence in their intimate relationships (Desmarais et al., 2012). Moreover, it is estimated that one in three males experience sexual violence, physical violence, and/or stalking at the hands of an intimate partner across their lifetime, with 97% experiencing these acts from a female intimate partner (CDC, 2021). Males are also subject to poly-victimization, with 67% of male survivors of physical intimate partner violence experiencing co-occurring emotional and psychological abuse (Drijber et al., 2013). Males also experience sexual IPV. This victimization can consist of being raped or being made to penetrate another. Being made to penetrate another is much more common; however, this form of victimization has an even lower likelihood of being perceived as rape by others as well as by the male victim (CDC, 2021). Perhaps due to these types of findings, male survivors of IPV are not only less likely to be identified but are also subjected to greater societal stigma (Bates et al., 2019). In fact, only 15% of US males who have experienced intimate partner violence reported it, with the most common reasons for underreporting being fear of not being taken seriously, followed by shame, as well as beliefs that legal authorities are unlikely to help (Drijber et al., 2013). Male survivors may indeed experience difficulties accessing legal protection (e.g., restraining orders) relative to females seeking legal protection. For example, females were shown to be 13 times more likely to be granted restraining orders against their perpetrators relative to male survivors (Muller et al., 2009). Relatedly, male survivors who report abuse are often labeled as primary aggressors, even when the violence is not mutual nor equivalent (Douglas & Hines, 2011). Finally, the narrative that women’s violence is in self-defense has been challenged by findings revealing that IPV is initiated at approximately equal rates between males and females (Harland et al., 2021). However, the prevailing narrative of male-to-female IPV perpetration has been supported by the typical sex-based differences in physical strength and size that can result in different consequences from same acts of violence perpetrated by men as compared to women. Consistent with this size differential, several studies have demonstrated that females are more likely than males to experience an IPV-related injury (Cascardi et  al., 1992). Consequently, female-perpetrated violence, if acknowledged, has been downplayed, as the “physical and psychological

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consequences of domestic violence are generally greater for women than men” (Saunders, 2002, p. 1436). However, in criminal justice data, drawn from a sample of individuals with domestic violence charges, females were just as likely as males to inflict severe injuries on their partner (Busch & Rosenberg, 2004). Female perpetrators may also be more likely than male perpetrators to use weapons, which can increase the injury potential for male victims (Chan et al., 2019).

Patriarchy Is Not the Sole Cause of Intimate Partner Violence The gender paradigm highlights patriarchy and male privilege as the principal causes underlying intimate partner violence. Yet, it is important to acknowledge that male patriarchy is likely only one out of many contributing factors to IPV perpetration (see Kimmes et al., 2019 for a review). Others include socioeconomic risk factors (e.g., financial stress; Slep et al., 2010), adverse childhood experiences (e.g., exposure to IPV in the family of origin; Gil-Gonzalez et al., 2008), psychological factors (e.g., impulsivity; Romero-Martínez et al., 2021; psychopathy, Hoffmann & Verona, 2019), behavioral risk factors (e.g., substance use; Temple et al., 2013), as well as relationship-specific risk factors such as jealousy (Powers & Kaukinen, 2020) and frequent conflict (DeMaris et al., 2003). Although most risk factors are considered to be “gender neutral,” universal risk factors such as demand/withdrawal relationship patterns are generally described as conforming to a female (demand) to male (withdrawal) gender-stereotyped pattern (Spencer et  al., 2022). Similarly, while self-reported motivations (e.g., power, jealousy, self-defense) for IPV perpetration appear to be quite similar for men and women  (Langhinrichsen-Rohling et al., 2012a), perceivers tend to interpret males’ motivation to perpetrate violence as rooted in dominance or control, whereas female violence and aggression is mostly attributed to emotional states such as feeling angry, scared, or hurt (Leisring, 2013; Scarduzio et al., 2017). These perceptions likely further stigma as it pertains to help seeking among male victims (Douglas & Hines, 2011).

Bi-Directional IPV Is Prevalent Another implicit assumption of the gender paradigm is that the IPV is a unidirectional event transpiring from the male to the female. As noted above, this assumption has repeatedly been challenged in prevalence studies revealing similar rates of IPV perpetration for males and females (Harland et al., 2021). Further challenging this component of the gender paradigm is data obtained on the IPV perpetration behaviors of both partners in the same relationship. Results from these studies consistently demonstrate that bi-directional violence is the most frequent pattern among violent couples. Bi-directional violence is typically twice as likely as unidirectional male-to-female violence and unidirectional female-to-male violence, which have

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similar prevalence rates in a variety of populations. The considerable rates of bidirectional violence have been observed across population-based samples, among couples seeking marital therapy, college students, and domestic violence perpetrators (Langhinrichsen-Rohling et  al., 2012b). The occurrence of bi-directional violence, which is a common IPV pattern and may also be a frequent configuration of sibling violence, raises an important question. To what extent should the dynamics of the relationship in which the violence is occurring be considered as an antecedent, trigger, or risk factor for the aggression?

I ntimate Partner Violence Occurs Outside of Heterosexual Relationships In yet another challenge to the gender paradigm, lesbian, gay, bisexual, transgender, queer, and others (LGBTQ+) identified individuals have been shown to experience significantly more violence victimization/survivorship compared to heterosexual individuals (e.g., Palmer et al., 2021). For example, among patients seeking care at emergency departments, sexual minority patients reported higher rates of IPV perpetration by both current and former partners (Harland et al., 2021) compared to heterosexual patients. Individuals identifying as bisexual appear to experience the highest rates of IPV violence (Kiekens et al., 2021). Furthermore, 75% of transgender and gender non-conforming identified adults have experienced at least one form of IPV in their lifetime (Henry et al., 2021). Yet, current terminology (i.e., referring to IPV as violence against women) and gendered theoretical frameworks leave little room for the IPV experiences of gender and sexually diverse individuals (Reed et al., 2010). For example, violence between two female-identified people in same-­ sex or queer relationships is often not considered violence against women as this specific phrase defines IPV as stemming from male patriarchy (i.e., perpetrated by males against females; Dutton, 2012). Advantages and disadvantages at the intersection of social identities (e.g., sexual orientation, gender identity, sex, race, socioeconomic status) exert a significant impact on relationship dynamics, including IPV perpetration and victimization/survivorship experiences (Cannon & Buttell, 2016). Therefore, conceptualizing and studying IPV among members of the LGBTQ+ population specifically requires the consideration of multiple social identities, including the role of sexual and gender minority stress (i.e., social stressors that are unique from those experienced by heterosexual cisgender individuals), as well as a consideration of ongoing and historical experiences of stigmatization and marginalization. Minority stress theory (Meyer, 2003) delineates a unique set of stressors (e.g., homophobia, transphobia, and cisgenderism) experienced by LGBTQ+ people associated with IPV perpetration and victimization/survivorship (e.g., Longobardi & Badenes-Ribera, 2017). LGBTQ+ specific stressors may also be weaponized by intimate partners. For example, coercive control tactics may include attempts to control gender identity or

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expression (e.g., denying access to clothing that aligns with gender identity) and identity abuse such as outing (i.e., disclosing gender or sexual identity to others without the individual’s permission/knowledge) or threats of outing, name-calling, misgendering, restricting access to support in the LGBTQ+ community, and/or pressuring the partner to conform to sex or gender norms (Rogers, 2019). Consequently, IPV may have diverse presentations within the LGBTQ+ community, which need to be acknowledged. While most attempts to address and combat the marginalization of the LGBTQ+ community have taken the form of theoretical contributions and descriptive qualitative work grounded in empiricism, the measurement and assessment of IPV in the LGBTQ+ community remains underdeveloped. IPV among sexually and gender diverse couples is inconsistently defined across studies and perpetrator/survivor roles are either not assigned or considered mutually exclusive (Stiles-Shields & Carroll, 2015). Additionally, most IPV assessments have been developed based on heterosexual couples, although some have been re-normed for specific queer populations (Peterson et  al., 2020). For example, the Conflict Tactics Scale  - Revised (CTS-2; Straus et al., 1996) is the most widely used measure of family and intimate partner violence; it focuses on episodes of conflict and asks respondents to report the presence/absence and frequency of experiencing particular acts during the disagreement (Jones et al., 2017). Yet, aside from the revision to include gender neutral terms (i.e., “my partner” rather than “my husband”), CTS-2 item content remains non-representative of sexual and gender diverse IPV experiences. For example, the item “made me have sex without a condom” is heteronormative. While it may be relevant for males who have sex with males, it is likely irrelevant or even offensive when addressing IPV in the same-sex or queer relationships of those assigned female at birth. Thus, the measure’s wide use to assess violence in LGBTQ+ populations is concerning (Kim & Schmuhl, 2021). Simple re-norming of existing measures is insufficient as they will not effectively characterize the unique relational experiences of queer-identified individuals (Peterson et  al., 2020). Therefore, the validity and reliability of IPV prevalence rates in gender diverse samples continues to be limited (i.e., measurement; Hardesty & Ogolsky, 2020).

 ender and IPV Perpetration: Disentangling the Role of Nature G and Nurture The relation between gender and IPV has joined one of the oldest controversies in psychological sciences: the nature–nurture debate. One line of argument focuses on biological structures and processes (i.e., nature) while the other references sociocultural influences (i.e., nurture) as the underlying mechanism for gender differences in the victimhood/survivorship or perpetration of aggression. In support of the role of “nature” are biological and evolutionary theories that advance the idea that males perpetrate violence because of innate risk factors unique to male biology. Biological

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theories assert that violence perpetration is the result of specific combinations of chromosomes, hormones, and genetics. This position is generally supported by research highlighting the relative importance of biological correlates such as cortisol or testosterone in the production of violence and aggression in animals as well as humans (e.g., Cordero et al., 2012). Evolutionary psychology offers another take on the role of nature in male-perpetrated violence and aggression. One evolutionary explanation for the IPV gender paradigm is the Male Sexual Proprietariness Theory (Wilson & Daly, 1993), which suggests that male sexual jealousy and possessiveness are the primary psychological mechanisms underlying male IPV perpetration. Other evolutionary psychology frameworks such as Buss (1988)’s mate retention tactics describe similar root causes of IPV (i.e., sexual jealousy), with male-­ perpetrated IPV being framed as one of many reproductive strategies. Yet, while evolutionary psychology provides an explanation for IPV that is consistent with the gender paradigm, it has difficulty explaining the occurrence of IPV in sexual and gender diverse relationships. These theories also discount the influence of societal phenomena (e.g., recent cultural contexts) and social learning in the development and maintenance of IPV (the nurture component). Within the age-old “nature–nurture debate,” many leading researchers in the field have attempted to model and understand patterns of heterogeneity within perpetration and victimization experiences through the lens of different theoretical frameworks. Among those, social-learning and social-cognitive theories focus on the role of nurture when explaining gender differences in the expression of IPV and familial aggression. Within the nurture-focused theories, childhood exposure to family violence is one of the most consistent predictors of IPV perpetration (e.g., Smith et al., 2011). Violence exposures in childhood serve as observational models that foster the development of violence-accepting attitudes within children (e.g., seeing parents commit IPV helps children learn that aggression and violence are acceptable or even normative within close relationships; Jouriles et al., 2012). Pursuant to this, experiences of violence in the family of origin show evidence of gender differences in the directionality of its effect such that exposure to IPV in the family of origin increases the likelihood of male perpetration and female victimization (Smith-­ Marek et al., 2015). In other words, the intergenerational transmission of violence from the family of origin to emerging dating and romantic relationships may be both role- and gender-specific (Eriksson & Mazerolle, 2015), with traditional attitudes about male–female relationships particularly increasing the risk of violence perpetration among males (Lichter & McCloskey, 2004). Findings regarding sociocultural, family-of-origin, and individual factors predicting IPV perpetration indicate that more complete models of violence must consider interactions among these influences as they unfold over time. As such, nested ecological framework theories such as Bronfenbrenner’s bioecological model (Bronfenbrenner & Ceci, 1994) have gained popularity given their focus on the interaction among risk factors for violence perpetration and the interplay of individual, familial, and sociocultural level factors over time. For example, a husband who perpetrates physical violence against his wife may be understood as an amalgam of his experience of violence in his family of origin, or

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his lack of access to mental health services due to stigma, in conjunction with his uptake of sociocultural narratives about masculinity discouraging emotion. Finally, recent attempts to expand typologies of IPV to include intersecting violent and controlling behaviors (e.g., Mennicke, 2019) provide promising future directions for more expansive IPV conceptualization above and beyond the gender paradigm. In sum, the emerging typologies of IPV and bioecological frameworks aid the conceptualization of perpetrators and victim-survivors.

3 Practical Implications and Future Directions Clearly, IPV is a highly prevalent public health concern and lies at the heart of family violence as it provides a model for children’s eventual romantic relationships and sibling violence, and changes the capacity of parents to provide nurturing, safe, non-violent care to children. At the outset, IPV was almost completely understood and addressed as a gendered phenomenon, with perpetrators assumed to be male and victims/survivors assumed to be female. However, this chapter has highlighted numerous challenges to the traditional IPV gender paradigm. We briefly considered the role of theory and sociocultural narratives in recognizing and conceptualizing sex and gender differences in the perpetration and victimization/survivorship of intimate partner violence. To advance, we believe it is important to discern the intended and unintended consequences of rigidly applying the gender paradigm to understand, measure, and address family violence. Additionally, given that poly-­ victimization is common with high co-occurrence rates among different types of violence and among different constellations of family members (Chan et al., 2021), we believe that it is important to address family violence with a socio-ecological-­ biological-developmental and systems-sensitive lens. Providers need to acquire and integrate knowledge about intimate partner violence, child maltreatment, sibling violence, intergenerational transmission processes, and violence against LGBTQ+ individuals. Therefore, the gender-specific challenges described in this chapter are meaningful for the field of family violence at large. As family violence prevention efforts require a successful integration of research and practice, we provide four major takeaways to inform practice and future directions.

Takeaway 1: Binarism Is a Slippery Slope Considering prevailing narratives regarding male perpetration and female victimization/survivorship, it is crucial to acknowledge the limitations imposed by categorical thinking. For one, it remains particularly important to recognize the potential vulnerability of male and LGBTQ+ identified survivors, as well as the perpetration of violence by females for reasons other than self-defense. As such, perpetrator and victim status may not always be mutually exclusive and therefore

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best captured using a dimensional approach (e.g., considering a continuum of conflict and control as well as other motives, impacts, and contexts). Moreover, given that lived experiences of intimate partner and family violence are not ubiquitous, treatment of perpetrators and survivors should be inclusive and tailored to individual needs. For instance, in the context of relationship violence intervention programs (i.e., perpetrator treatment; Levittan et al., 2020), practitioners are urged to take a dimensional approach to violence assessment and treatment that considers demographic factors, power differentials, readiness to change, and the presence of other co-occurring concerns (e.g., substance use; Butters et al., 2021). These may be as, if not more, important to consider. Moreover, addressing intimate partner and family violence from a socio-ecological perspective acknowledges system-level contributors to harmful and dysfunctional relationship dynamics above and beyond the characteristics of a particular individual. Taking these factors into account may help explain how some people perpetrate and experience violence in some, but not all, relationships and situational contexts.

Takeaway 2: Embracing Heterogeneity Is Key Notwithstanding a generally increased focus on intimate partner violence among LGBTQ+ couples, family violence research has had a difficult time keeping up with the sexual and gender diversity present within families. Definitions of what constitutes a family need to be revisited to be inclusive of the experiences of LGBTQ+ individuals. Moreover, sexual and gender minorities, especially youth, are extremely vulnerable to experiencing family violence (physical, sexual, and emotional) as well as targeted aggression such as identity abuse and/or rejection (e.g., Grossman et al., 2021; McGeough & Sterzing, 2018). Yet, the experiences of queer families are largely overlooked in family process research, with only 3% of the top family journals publishing research on queer families (van Eeden-Moorefield et al., 2018). As such, alternative configurations (e.g., queer relationships) as well as less acknowledged and poorly studied experiences of violence (e.g., identity abuse or other violent acts unique to the experiences of sexual and gender minority individuals) have been largely neglected. Given that currently available screening and measurement tools to assess violence in romantic and family contexts also largely exclude the experiences of non-traditional victims and survivors (i.e., violence between siblings and male survivors), practitioners’ efforts may be best supported through the development of new screening tools that both broaden the assessment of violence to include various relational constellations and include a diverse set of experiences and behaviors. Furthermore, both family violence researchers and practitioners should carefully consider their existing assumptions about which situations warrant further assessment and possible intervention related to family violence; these are likely to need expansion. Lastly, researchers and practitioners are encouraged to challenge their own biases through consultation with sexual and gender

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diversity specialists or through additional training/scholarship in these important areas.

Takeaway 3: One-Direction Is the Wrong Direction Current definitions and measures of family and intimate partner violence have difficulty accommodating the complexity and dynamism of interpersonal relationships (including bi-directionality and intersectionality considerations). Therefore, knowledge about intimate partner violence, child maltreatment, sibling violence, intergenerational transmission processes, and violence against LGBTQ+ individuals will require integration. We propose that explanations of both intimate partner and family violence, as well as their operationalization and measurement are revised to consider intersecting structures of oppression (De Coster & Heimer, 2021). Accordingly, measurement tools assessing a diverse range of survivorship and victimization experiences as well as bi-directionality of perpetration behaviors are needed  (Langhinrichsen-Rohling, 2010). This will require researchers to operationalize sex and gender (identity/expression), with intention, as two separate and yet at times interrelated constructs, embedded within a larger system of intersecting identities that create the potential to exert and maintain power and control. Moreover, as different types of family violence are interconnected via micro- and macro-system factors, screening patients for past and current maltreatment and abuse in primary care and emergency care settings may be a critical step in advancing family violence intervention and also preventing future cases of IPV (see Langhinrichsen-Rohling et  al., 2020 for best practice recommendations). Finally, screening should be accompanied by interventions at the individual (e.g., psychoeducation about violence and healthy relationships) and micro-system level (e.g., conflict-resolution or parenting skills) to disrupt the intergenerational transmission of violence.

Takeaway 4: Family Violence Is Structural Violence Although current prevention and intervention efforts target individuals and their micro-system (i.e., relational) contexts, the influence of larger external systems remain widely neglected (Hardesty & Ogolsky, 2020). For instance, screening for exposure to family violence in educational and primary care settings may increase the early identification of individuals at risk. At the same time, other characteristics such as neighborhood safety may represent important proximal systemic factors that can also increase the likelihood of exposure to family violence (including child abuse; Fontes, 2020). These factors require consideration in intervention and prevention efforts. As such, building on existing prevention efforts that focus on unequal access to determinants of health and social systems (e.g., prevention of

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adverse childhood experiences) may represent an important avenue for family violence prevention practices. Finally, there remains a need for both researchers and practitioners to utilize a holistic approach that explicitly incorporates biological, individual, family, and sociocultural factors to understand the multifaceted nature of family violence and to effectively serve individuals and the families in which they are nested.

4 Concluding Remarks As highlighted throughout this chapter, gendered conceptualizations of IPV specifically, and family violence more broadly, may dictate which behaviors (e.g., sexual coercion, physical harm) or relationship constellations (e.g., heterosexual relationships, parent–child relationships) are worthy of focus. Moreover, the gender paradigm has contributed to an over-socialization of violence-related gender roles along the gender binary that has resulted in arrest and intervention policies that frame violence as a completely gendered problem. Thus, there is a great need for research and practice to be affirming and validating of all survivors’ experiences, regardless of whether they fit the prevailing paradigm or not. Relatedly, it is imperative for both researchers and practitioners to use appropriate language and terms; this will require knowledge about diverse family structures, including familyspecific definitions of key terms and aspects, as well as affirming language, especially as it pertains to gender, sexuality, or other various intersecting identities (Struve & Colrain, 2020). A successful application of such knowledge will also require the recognition of own intersecting identities (e.g., sex, gender, race, sexual orientation, etc.) and their impact on beliefs about violence, its different forms, and the behaviors of perpetrators and victims. Finally, assessments of violence need to explicitly acknowledge intersectionality. While corresponding measure development is needed, practitioners may already start this by asking broad verbal or paper/ electronic form questions regarding “safety” (e.g., “Do you feel safe at home?” “Have you ever had an experience where you felt trapped, frightened, or controlled by another person?”). These encourage self-reporting a diverse range of violence experiences and can function to prompt further individualized assessment of areas of concern.

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Douglas, E. M., & Hines, D. A. (2011). The helpseeking experiences of men who sustain intimate partner violence: An overlooked population and implications for practice. Journal of Family Violence, 26(6), 473–485. https://doi.org/10.1007/s10896-­011-­9382-­4 Dowd, L., & Lambo, L. (2020). Female perpetrators of intimate partner violence. In R. Geffner, J. W. White, L. K. Hamberger, A. Rosenbaum, V. Vaughan-Eden, & V. I. Vieth (Eds.), Handbook of interpersonal violence and abuse across the lifespan (pp.  1–26). Springer International Publishing. https://doi.org/10.1007/978-­3-­319-­62122-­7_160-­1 Drijber, B.  C., Reijnders, U.  J. L., & Ceelen, M. (2013). Male victims of domestic violence. Journal of Family Violence, 28(2), 173–178. https://doi.org/10.1007/s10896-­012-­9482-­9 Dutton, D. G. (1994). Patriarchy and wife assault: The ecological fallacy. Violence and Victims, 9(2), 167–182. https://doi.org/10.1891/0886-­6708.9.2.167 Dutton, D. G. (2012). The case against the role of gender in intimate partner violence. Aggression and Violent Behavior, 17(1), 99–104. https://doi.org/10.1016/j.avb.2011.09.002 Dutton, D.  G., Corvo, K.  N., & Hamel, J. (2009). The gender paradigm in domestic violence research and practice part II: The information website of the American Bar association. Aggression and Violent Behavior, 14(1), 30–38. https://doi.org/10.1016/j.avb.2008.08.002 Eriksson, L., & Mazerolle, P. (2015). A cycle of violence? Examining family-of-origin violence, attitudes, and intimate partner violence perpetration. Journal of Interpersonal Violence, 30(6), 945–964. https://doi.org/10.1177/0886260514539759 Few-Demo, A.  L., & Allen, K.  R. (2020). Gender, feminist, and intersectional perspectives on families: A decade in review. Journal of Marriage and Family, 82(1), 326–345. https://doi. org/10.1111/jomf.12638 Figge, C. J., Martinez-Torteya, C., Bogat, G. A., & Levendosky, A. A. (2021). Child appraisals of interparental conflict: The effects of intimate partner violence and parent–child relationship quality. Journal of Interpersonal Violence, 36(9–10), NP4919–NP4940. https://doi. org/10.1177/0886260518794509 Fontes, L.  A. (2020). Cultural competence in the field of child maltreatment. In R.  Geffner, J. W. White, L. K. Hamberger, A. Rosenbaum, V. Vaughan-Eden, & V. I. Vieth (Eds.), Handbook of interpersonal violence and abuse across the lifespan (pp.  1–22). Springer International Publishing. https://doi.org/10.1007/978-­3-­319-­62122-­7_16-­1 Gil-Gonzalez, D., Vives-Cases, C., Ruiz, M.  T., Carrasco-Portino, M., & Alvarez-Dardet, C. (2008). Childhood experiences of violence in perpetrators as a risk factor of intimate partner violence: A systematic review. Journal of Public Health, 30(1), 14–22. https://doi.org/10.1093/ pubmed/fdm071 Grossman, A. H., Park, J. Y., Frank, J. A., & Russell, S. T. (2021). Parental responses to transgender and gender nonconforming youth: Associations with parent support, parental abuse, and youths’ psychological adjustment. Journal of Homosexuality, 68(8), 1260–1277. https://doi. org/10.1080/00918369.2019.1696103 Hamby, S., Finkelhor, D., Turner, H., & Ormrod, R. (2011). Children’s exposure to intimate partner violence and other family violence. U.S. Department of Justice. http://www.ncdsv.org/ images/OJJDP_Childen'sExposureToIPVandOtherFV_10-­2011.pdf Hardesty, J.  L., & Ogolsky, B.  G. (2020). A socioecological perspective on intimate partner violence research: A decade in review. Journal of Marriage and Family, 82(1), 454–477. https://doi.org/10.1111/jomf.12652 Harland, K. K., Peek-Asa, C., & Saftlas, A. F. (2021). Intimate partner violence and controlling behaviors experienced by emergency department patients: Differences by sexual orientation and gender identification. Journal of Interpersonal Violence, 36(11–12), NP6125–NP6143. https://doi.org/10.1177/0886260518812070 Heise, L., Ellsberg, M., & Gottmoeller, M. (2002). A global overview of gender-based violence. International Journal of Gynecology & Obstetrics, 78, S5–S14. https://doi.org/10.1016/ S0020-­7292(02)00038-­3 Henry, R. S., Perrin, P. B., Coston, B. M., & Calton, J. M. (2021). Intimate partner violence and mental health among transgender/gender nonconforming adults. Journal of Interpersonal Violence, 36(7–8), 3374–3399. https://doi.org/10.1177/0886260518775148

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Chapter 4

Gay and Lesbian Families and Violence Lisa K. Waldner

An editorial in the journal of Partner Abuse lamented the knowledge lag regarding same-sex intimate partner violence (IPV) and argued that because research shows that rates of violence are equal when compared to heterosexual couples and in some cases, higher, “IPV is not (author’s emphasis) a heterosexist problem but a social problem” (Russell, 2015, p.  4). Thus, for over 25  years a growing number of researchers have called attention to the lack of queer inclusion in IPV and family violence research (Balsam et al., 2011; Duke & Davidson, 2009; Hester & Donovan, 2009; Houston & McKirnan, 2007; Jacobson et  al., 2015; Laskey, 2021; Laskey et al., 2019; Long et al., 2007; Murray & Mobley, 2009; Oringher & Samuelson, 2011; Richardson et  al., 2015; Todahl et  al., 2009; Waldner-Haugrud, 1999; Waldner-Haugrud & Gratch, 1997). While research knowledge on same-sex IPV is growing (Stephenson et al., 2019; Loveland & Raghavan, 2014), the focus has mostly been on female heterosexual victims (Laskey et al., 2019) with only 3% of all studies published between 1993 and 2013 on sexual minority populations (Edwards et al., 2015). Family violence is broader than IPV research and queer families also include children and other family members. We know that sexual minorities have a higher risk of experiencing family violence including childhood (sexual, physical, and psychological abuse) and adult victimization (Balsam & Szymanski, 2005). Yet, most of the work on queer family violence focuses on intimate partners. Despite the paucity of research and methodological challenges to existing work, there are some areas of researcher convergence. These include: (1) sexual minorities experience the same or a higher level of IPV compared to heterosexual individuals; (2) among sexual minorities, bisexuals and transgendered persons have higher rates of victimization yet we know the least about bi and trans experiences; and (3) we know more about IPV experiences of L. K. Waldner (*) University of St. Thomas, St. Paul, MN, USA e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 P. Sturmey (ed.), Violence in Families, Advances in Preventing and Treating Violence and Aggression, https://doi.org/10.1007/978-3-031-31549-7_4

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lesbians than gay men. To organize this review, I begin with some definitions, review research findings on prevalence and correlates, examine barriers to same-sex IPV research including myths and methodological challenges, briefly summarize some theoretical perspectives for framing same-sex IPV, and finally discuss avenues for future research.

1 Definitions The World Health Organization defined IPV as “behaviour within an intimate relationship that causes physical, sexual or psychological harm, including acts of physical aggression, sexual coercion, psychological abuse and controlling behaviours perpetrated by current and former spouses or partners” (World Health Organization, n.d.). Like others (Bornstein et al., 2006), I use “queer” as an umbrella term to include all those who identify as gay, lesbian, bisexual, or transgender (GLBT). I also use “sexual minority,” especially when that phrase has been used by the researcher whose findings I am summarizing. I use “same-sex” to differentiate this body of work from heterosexual IPV. I recognize that for some bisexual and trans individuals, same-sex may not accurately reflect how they define their relationships. “Transgendered” or “trans” refers to individuals who have an identity or gender expression that differs from cultural expectations given their biological sex assignment at birth (Guadalupe-Diaz, 2019; Barrett & Sheridan, 2017; Guadalupe-Diaz & Jasinski, 2017; Calton et al., 2016).

Commonalities While there are aspects of IPV unique to certain segments of the queer community, Bornstein and colleagues (2006) identified some commonalities. First, it can be difficult to differentiate between the victim and perpetrator in queer relationships as signals like gender, size, or gender performance are not necessarily accurate indicators of who is the aggressor (Bartholomew et al., 2008; Stanley et al., 2006). Second, it is difficult for queer female victims to avoid their abusers as queer female perpetrators are able to access the same support services and resources offered to all women experiencing IPV. Third, queer victims who speak up about abuse risk accusations of betraying the queer community. Fourth, it is common for abusers to attack sexual and/or gender identity by accusing victims of either not being “gay enough” or “real” enough women or men. Bisexuals may have their identity turned against them by being accused of flirting with others. Some queer victims are pressured to have sex to prove their identity. Fifth, like heterosexual victims, queer survivors report isolation as an abuse tactic to sever their relationships with friends, family, and the community. Finally, sexual minorities report issues when seeking help even when working with a therapist who identifies as a sexual minority as these providers

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“failed to recognize abusive tactics, minimized violence, or made survivors feel responsible for their abuse” (Bornstein et  al., 2006, p.  173). Other research has demonstrated that shelter workers are less likely to define lesbians as victims, especially if abuse was emotional or psychological (Basow & Thompson, 2012). In sum, same-sex IPV is a widespread public health problem that is underrecognized and understudied.

2 Intimate Partner Violence Prevalence Despite methodological issues, there is agreement that the prevalence of violence for sexual minorities is equal to (Hellemans et al., 2015) and may even exceed heterosexual rates (Chen et al., 2019; Martin et al., 2011; Rothman et al., 2011; West, 2012). Nationally representative samples report lifetime prevalence rates for IPV (inclusive of sexual violence, physical violence, and stalking) of 43.5% and 30.7% for bisexual women and lesbians, respectively, compared to 27.6% for heterosexual women. For men, lifetime IPV was 11.4% for heterosexuals, 13% for bisexuals, and 18.1% for gay men (Chen et al., 2019). Abuse for a 12-month time frame that combined physical and psychological IPV found lesbians (18.1%) reporting slightly higher rates compared to heterosexuals (16.6%) (Addington, 2018, cited in Addington, 2020). When comparing female IPV victims of psychological, physical, or sexual abuse, bisexual women reported the highest rates of abuse (61.1%) followed by lesbians (43.8%) and heterosexual women (35.0%) (Walters et al., 2013). A study of gay men found a 5-year rate of 22% and 5% for physical and sexual IPV victimization, respectively, which is comparable to rates reported by heterosexual women (Greenwood et al., 2002). James and colleagues (2016) estimated that half of those identifying as transgender have experienced IPV and this finding was also replicated by Messinger and associates (2021) who reported a prevalence of 55%, suggesting that trans individuals have a higher risk of IPV than other groups (Langenderfer-Maugruder et al., 2016; Valentine et al., 2017). There are some generalizations from heterosexual IPV that also extend to same-sex IPV including: (1) victimization rates are higher when we researchers use a behavioral checklist and focus on lifetime prevalence; (2) less lethal forms of violence tend to exceed severe forms; (3) milder forms of sexual coercion and pressure exceed severe; and (4) victimization rates are higher than reported perpetration. Victimization rates also fluctuate between research studies depending on how violence is defined, and the period covered with higher rates reported for studies that measure lifetime prevalence rates (e.g., “Have you ever experienced…”) and use a behavioral checklist (e.g., Conflict Tactics Scale). Less lethal forms of violence exceed severe with emotional and verbal abuse reported at higher rates compared to physical or sexual abuse (Badenes-Ribera et al., 2016; Bartholomew et al., 2008; Messinger, 2014; Stephenson et al., 2019; Toro-Alfonso & RodrÍguez-Madera, 2004; Turell, 2000; Waldner-Haugrud et  al., 1997). The Stonewall Health Briefing (2012) reported that 23% of lesbian and

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bisexual women experienced emotional abuse (e.g., “belittled” and “made to feel worthless”) compared to 6% reporting forced sex and 4% threatened with death. The same pattern holds for gay and bisexual men with similar rates for emotional abuse (18%) and less severe physical violence (17%; being pushed, held down, or slapped) and lower rates for forced sex (9%) and death threats (4%). Other researchers have also confirmed higher rates of psychological or emotional victimization compared to physical or sexual aggression. For example, Hellemans et  al. (2015) found that 57.9% of their non-heterosexual sample experienced psychological victimization while a lower percentage experienced physical violence (14.4%); using a 12-month time frame, Stephenson et al. (2011) also found higher rates of psychological violence (33.0%) compared to physical (22.0%) and sexual violence (9.8%). Bartholomew et  al. (2008) reported nearly all of their sample experienced psychological violence (94%) with lower rates of physical (33.0%) and sexual abuse (10.0%). A comprehensive examination of 75 research articles on sexual victimization of gay, lesbians, and bisexuals reported intimate partner sexual assault and coercion estimates ranging between 9.5 and 57% for gay and bisexual men and 3 and 45% for lesbians and bisexual women (Rothman et al., 2011). Lesbians and bisexual women reported more sexual victimization when compared to heterosexual women (Martin et al., 2011). Gay men reported more sexual touching than penetration and the use of verbal pressure and exploiting a vulnerable state more often than physical force (Krahé et al., 2000). Rate differences in studies can be attributed to differing definitions of violence, measurement tools, and the time frame examined.

Correlates and Risk Factors We know more about the IPV experiences of lesbians than gay men (Houston & McKirnan, 2007; Stanley et al., 2006). Generally, we know much more about White lesbians than any other group despite the fact that persons of color are considered at higher risk for family violence (King et al., 2022; Reuter et al., 2017) (for an opposing view of race as a risk factor, see Houston & McKirnan, 2007). Alcohol and drug use is positively correlated with IPV generally (Houston & McKirnan, 2007; McKenry et al., 2006; Pimentel, 2015; Toro-Alfonso & RodrÍguez-Madera, 2004) and is possibly both a risk factor and a means of coping with past abuse. For example, bisexual women who experience sexual coercion have more negative consequences associated with drinking compared to non-victims (Kelley et  al., 2018). Other factors associated with a higher victimization risk include poor conflict resolution skills and experiencing childhood abuse (Toro-Alfonso & RodrÍguez-Madera, 2004). Low self-esteem, internalized homophobia, and high dependency on partners are also correlated with victimization (McKenry et  al., 2006). Stigma consciousness or not wanting to reinforce stereotypes about queer people is also associated with experiencing IPV (Rollè et al., 2018). Higher levels of masculinity for both men and women are associated with victimization (McKenry et al., 2006)

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and perpetration (Jacobson et al., 2015). Masculine expressing females also reported greater acceptance of IPV (Jacobson et al., 2015). The relationship between masculinity and increased victimization is not well understood with some speculation that masculine women victims are punished for transgressing gender norms or failing to adequately conceal their sexual identity (Jacobson et al., 2015). Emotional or psychological victimization is associated with lower levels of couple satisfaction (Stephenson et al., 2011) and depression is correlated with IPV for men who have sex with men (MSM) (Houston & McKirnan, 2007). Gay men who reported victimization also reported perpetration (Oringher & Samuelson, 2011; Stanley et  al., 2006) and more emotional and physical abuse (Stanley et al., 2006). Correlates of experiencing sexual violence include being HIV positive for men (Stephenson et al., 2011) and experiencing childhood sexual violence for both gay men (Balsam et al., 2011; Pimentel, 2015) and lesbians (Balsam et al., 2011; Hughes et al., 2010). Men who report higher levels of stigma for being in a same-sex relationship reported lower levels of sexual victimization. Stephenson and colleagues (2011) argued that this finding may be due to a perceived lack of support for same-­ sex relationships and suggested stigmatized men may be more reluctant to disclose sexual abuse. Abused lesbians reported much less ability to control aspects of their lives including how they dress, who they socialize with, and the ability to practice safe sex (Eaton et al., 2008).

Perpetration Compared to victimization rates, reported perpetration rates are lower, which could be a function of both social desirability or unwillingness to divulge negative information in surveys and/or a small number of perpetrators committing the majority of IPV. Perpetration rates for a sample of MSM follows the pattern seen with victimization rates with reported emotional abuse (30%) higher than either physical (20%) or sexual violence (9%) (Stephenson et al., 2011). Other reports also support the notion that milder forms of physical violence (e.g., pushing [29% lesbians/12% gay men] and slapping [17% lesbians/13% gay men]) exceed severe (e.g., punching [12% lesbians/9% gay men], striking with an object [4% lesbians/3% gay men]) (Waldner-Haugrud et al., 1997). The one exception to the general rule that milder forms exceed severe was the finding that penetration was a more common sexual outcome than kissing or sexual touching but this has not been replicated (Waldner-­ Haugrud & Gratch, 1997). We know much more about the correlates of victimization than perpetration. A review of the perpetration literature by Edwards and colleagues (2015) reported the following factors associated with some form of IPV: attachment or dependency issues, adherence to masculinity ideals, interpersonal challenges, substance use and abuse (also Kelley et  al., 2014, for MSM), psychological distress, aggression, reduced emotional vulnerability, greater need for control, low socioeconomic status, being a person of color, lower self-worth (also McKenry et al., 2006), higher

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stress, being HIV positive (also Stephenson et al., 2011), having childhood exposure to IPV, lower relationship quality, and having unprotected sexual intercourse. It should be noted that many of the risk factors for victimization are similar to risk factors for perpetration. Masculinity is a risk factor for perpetrating greater physical and sexual violence for gay men, MSM (Carvalho et al., 2011; Oringher & Samuelson, 2011), and lesbians (Jacobson et al., 2015; McKenry et al., 2006). (For an alternative view, see Balsam & Szymanski, 2005). Compared to non-abusers, lesbian batterers were more likely to have had a history of childhood physical abuse (Messinger, 2014), sexual abuse, problems with drugs and alcohol (Eaton et al., 2008), and negative personality traits including antisocial, aggression, borderline, and paranoid traits (Fortunata & Kohn, 2003). Some have noted other risk factors for perpetration, fitting a minority stress model such as not being “out” and internalized homophobia (Bartholomew et al., 2008; Carvalho et al., 2011; Kelley et al., 2014). Bidirectionality of abuse is also a factor. Some studies have established that both partners have inflicted and experienced abuse within the same relationship making it hard to identify who is the abuser and who is the victim (Bartholomew et  al., 2008; Stanley et al., 2006).

Bisexuals We do not know as much about bisexual experiences (Messinger, 2014), and some have argued that bisexuality has been ignored either by not including bisexuals in samples or combining responses with lesbians and gay men (Callan et al., 2021; Finneran & Stephenson, 2013). Chen and associates (2019) found that both bisexual men and women report higher rates of sexual violence when compared to heterosexuals, and, when compared to gays and lesbians, bisexuals were more likely to report a rape history (bisexual men 13.2%, bisexual women 16.9%) than gay men (11.6%) or lesbians (15.5%). The differences were not statistically significant (Balsam et al., 2005). A review of the victimization literature confirms the overall higher risk of IPV for bisexuals compared to gay men, lesbians, and heterosexuals (West, 2012). Bisexual respondents report being threatened with outing (Halpern et  al., 2004) and a reluctance to engage with victim service providers. Bisexuals have a more difficult time managing stigma (Rollè et al., 2018) compared to gay men and lesbians and may face pressure from both heterosexuals and gays for choosing one identity over the other (Calton et al., 2016).

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Transgender Experiences Researchers need to think beyond the gender binary to consider how the experiences of those with more complicated gender identities may be unique and different (Guadalupe-Diaz, 2019). As one author stated, “often in studies addressing domestic violence in LGBT communities, the ‘T’ is tacked on at the end as an afterthought” (Greenberg, 2012, p.  200; see also Walker, 2015). Thus, trans experiences are aggregated with the responses of cisgender gays and lesbians (Guadalupe-Diaz, 2019). Given the conceptual differences between gender identity and sexual orientation (Calton et al., 2016), it is not appropriate to aggregate responses given the tendency to conflate these concepts (Yerke & DeFoo, 2016) and there is variation in how transgendered individuals define their sexual orientation with some identifying as heterosexual and others as bisexual or pansexual. (See the Trans PULSE study as reported in Bauer et al., 2013.) In a review of studies that included some trans individuals, Yerke and DeFoo (2016) write: “when transgender people are so grossly underrepresented in LGBTQ samples…no conclusions can be drawn specific to transgender people and IPV” (p. 977). Other researchers concur with this criticism (Barrett & Sheridan, 2017; Calton et al., 2016; Guadalupe-Diaz, 2019; Guadalupe-Diaz & Jasinski, 2017; West, 2012). Yet, there is a belief among researchers that trans persons suffer from higher rates of IPV compared to either heterosexual or gay and lesbian persons (Ard & Makadon, 2011; Barrett & Sheridan, 2017; Langenderfer-Maugruder et al., 2016). Estimates for IPV victimization for trans persons vary between about half (King et al., 2022; Messinger et al., 2021; Risser et al., 2005 [physical aggression only]) and 31% (Langenderfer-Maugruder et al., 2016). Of those that experienced IPV, the most common type is controlling (43%), followed by physical (39%), identity (31%), and sexual (25%) (Messinger et al., 2021). Identity IPV is a subtype of psychological abuse and involves questioning whether a trans person is a “true” man or woman and involves a number of behaviors that undermine trans identity or make it difficult for an individual to present themselves as a specific identity. Risser et al. (2005) also found greater prevalence of physical IPV (50%) compared to sexual victimization (25%). The 2015 Transgender survey found that almost half of the sample reported some type of psychological victimization including being told they were not a real man or woman (identity 28%), isolation from family and friends (26%), prevented from leaving the house (17%), stalking (18%), threats to “out” them (12%), and threats to call the police (12%) (King et al., 2022). Other research has looked at “violence in the home” (Barrett & Sheridan, 2017) and have found that between 56% (Kenagy, 2005, as cited in Barrett & Sheridan, 2017) and 66% of transsexuals (Kenagy & Bostwick, 2005, as cited in Barrett & Sheridan, 2017) have experienced violence committed by parents, siblings, and partners. Trans IPV victims report that abusers undermine their identities. As one researcher explains it, part of the abuse for trans victims is “manipulating the external cultural hostility that exists against those who transgress the gender binary in an effort to control…identity” (Guadalupe-Diaz, 2019, p.  3). These tactics include

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ridiculing or questioning gender presentation, using the wrong pronoun or “it,” hiding items used as markers of gender identity (e.g., breast binder, wigs) (Barrett & Sheridan, 2017; Cook-Daniels, 2015; Guadalupe-Diaz & Jasinski, 2017; Yerke & DeFoo, 2016), and withholding resources to pay for hormones and other medical services needed for those transitioning (Yerke & DeFoo, 2016). Abusers may also target unwanted body parts that are inconsistent with gender identity or target areas of the body that are gender identity markers (e.g., hair, chest, or genitals) (Goodmark, 2013). Like gay and lesbian victims, threats of “outing” are used to discourage trans IPV victims from reporting abuse or leaving a relationship (Ard & Makadon, 2011). Abuse may be motivated by the loss or threats to the perpetrator’s identity. When a partner comes out as transgender, that threatens the identity of other partner who may lash out as a result (Walker, 2015). There are some myths specific to transgender IPV that are based on transphobic assumptions. For example, asking whether a trans individual disclosed their status to an intimate partner suggests not only that trans individuals regularly hide their transgender status but also that failure to disclose justifies the violence (Barrett & Sheridan, 2017; Guadalupe-Diaz, 2019). Risk factors for IPV include beginning the process of physical transformation (Barrett & Sheridan, 2017); trying to initiate safe sex practices with partners (Heintz & Melendez, 2006); having engaged in sex work; substance abuse; identifying as a trans man (for an opposing view, see Reuter et al., 2017); being a person of color, low income, or education; being between the ages of 25 and 64; and having been part of a religious or spiritual community (King et al., 2022). How these experiences affect the dynamics of IPV is not well understood. Much less is known about trans perpetrators. Specific methods to avoid taking responsibility for violence or to discourage reporting of violence include using hormonal changes as an excuse for perpetrating violence, discouraging victims from disclosing abuse as a form of allyship to the trans community, and claims that those reporting abuse are unsupportive of transgender identity (Barrett & Sheridan, 2017; Cook-Daniels, 2015). Genderism, or the cultural system that recognizes and reinforces a gender binary, affects how victims perceive their abuse and is a barrier to seeking assistance (Guadalupe-Diaz, 2019; Guadalupe-Diaz & Jasinski, 2017). Even when trans individuals recognize themselves as victims and want to leave their abusers, they face discrimination and harassment from law enforcement and shelters that have policies excluding trans persons from receiving services or require proof of having undergone trans-related medical procedures (Yerke & DeFoo, 2016). Shelters sponsored by queer organizations that are willing to admit trans victims may find victims who do not define themselves as belonging to the gay community because they identify as heterosexual (Tesch & Bekerian, 2015). Many of the reasons that lesbian, gay, and bisexual individuals avoid services for domestic violence are also relevant for non-binary or trans individuals including fear of outing, lack of legal protections,

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stigma, and attitudes of service providers including police and medical personnel (Ard & Makadon, 2011; Greenberg, 2012; Guadalupe-Diaz & Jasinski, 2017). Messinger and colleagues (2021) report that 16% of their survivors seeking assistance reported transphobic discrimination. Factors associated with seeking assistance included having a higher income and being assigned as a female at birth. While experiencing any form of IPV increased the odds of seeking help, those experiencing controlling IPV were more likely to seek assistance while those experiencing sexual IPV were less likely. As a result, transgendered individuals are much more likely to seek informal sources of support within the GLBT community or “trans-specific spaces” rather than turning to formal organizations (Barrett & Sheridan, 2017, p. 154). Several recommendations have been made to better understand the IPV risk of trans persons. These include: (1) use gender identifiers that are inclusive of trans and non-binary individuals (Yerke & DeFoo, 2016); (2) if transgender respondents are included in queer samples, ensure adequate representation by collecting large and diverse samples (Calton et al., 2016; Yerke & DeFoo, 2016); and (3) transgender people should be the focus of IPV studies rather than omitted or combined with other groups to ensure fully understanding their unique experiences (Yerke & DeFoo, 2016).

Sexual Minority Adolescents and College Students Most of this review has focused on adult victimization but dating and relationship histories begin in adolescence, so more IPV research should focus on this lifecycle phase. When compared to heterosexual counterparts, sexual minority adolescents report more IPV including both victimization and perpetration across all violence types (physical, sexual, and psychological, including identity IPV). A national study found that about 25% of a same-sex sample reported some form of IPV. Like adults, lesbians reported more physical and psychological abuse compared to gay males (Halpern et al., 2004). Compared to heterosexuals, sexual minority youth were more likely to report sexual contact when too intoxicated to give consent, sexual violence, and threats of sexual violence with 8.1% reporting at least one act of sexual violence and some reporting injuries from those incidents ranging from a black eye to an internal injury. Sexual minorities compared to heterosexuals were less likely to report seeking help to avoid blame (Richardson et  al., 2015). When comparing bisexual and heterosexual youth, bisexual males reported higher levels of all types of IPV while females reported more sexual abuse (Freedner et al., 2002). Bisexuals may experience less acceptance from both heterosexuals and other queers rendering them more vulnerable to abuse (Freedner et al., 2002). In comparison to gay and lesbian adolescents, bisexuals reported higher levels of perpetration but not victimization (Reuter et al., 2015) and were more concerned about outing (Freedner et al., 2002). The latter study also found that traditional risk factors such as alcohol use and exposure to inter-parental violence did not predict IPV. Transgender youth are

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at higher risk for physical and sexual IPV compared to cisgender youth (Dank et al., 2014), with one in four transgendered youth reporting experiencing physical and sexual abuse at the hands of their dating partner (Veale et al., 2015). They are also more likely to report perpetrating physical IPV (Dank et al., 2014).

Summary In summary, sexual minorities have a higher likelihood of experiencing some form of IPV throughout their lifetime compared to heterosexuals, with bisexuals and trans individuals having the highest victimization rates. We need much more research to understand the experiences of bisexual and trans IPV victims including how stigma both increases the risk of violence and discourages the reporting of IPV. Patterns of IPV reveal that psychological or emotional violence is more likely to be reported compared to physical or sexual IPV. Perpetration is less likely to be reported compared to victimization and we know much more about victimization experiences than what motivates or correlates with perpetration. Finally, given that adolescence is a time for expressing sexual identity and intimate relationship socialization, researchers need to spend more time understanding IPV experienced as an adolescent and how this might influence adult relationships.

3 Research Barriers The lag in same-sex IPV research is explained by many factors including homophobic and transphobic attitudes, a reliance on the feminist paradigm that views men as perpetrators and women as victims (Russell, 2015), acceptance of myths regarding same-sex IPV, the reluctance of the queer community to acknowledge IPV as a problem, and methodological difficulties. Homophobic attitudes have rendered queer people invisible to researchers who historically have viewed homosexuality through a deviance lens (Burke & Follingstad, 1999) and researchers have generally been uninterested in the lives of queer people (Duke & Davidson, 2009; Messinger, 2014). Cannon and Buttell (2016) argued there is a hierarchy in IPV research with most focused on male-perpetrated violence against females followed by female perpetration against male partners with same-sex IPV as a distant third. Feminism, while credited with calling attention to wife battering, has been blamed as an impediment to seeing violence in queer relationships (Rollè et  al., 2018; Russell, 2015). Besides sampling and other methodological issues, other barriers for research include several myths (Oskarsson & Strand, 2021), and a community reluctance to acknowledge IPV (Rollè et al., 2018).

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Queer Family Violence Myths In their review, Oskarsson and Strand (2021) identified four myths regarding same-­ sex IPV including: violence is rare, lesbian utopia, the male perpetrator, and mutual combat. These myths are both gendered and intertwined. Rollè et al. (2018) argued that because queer family violence has been ignored by researchers, the public considers this uncommon. Believing violence is rare is connected to lesbian utopia or the belief that lesbian relationships are conflict-free (Hassouneh & Glass, 2008). Lesbian utopia is rooted in stereotypical gender roles where women are passive and nurturing and not aggressive or violent. Even when we acknowledge women perpetrators, we often assume that violence is associated with the more masculine presenting partner (Guadalupe-Diaz, 2019). Lesbian utopia promotes the false idea that lesbian relationships are violence-free and when the rare instance occurs, the severity is less because two women cannot inflict the same amount of pain compared to male-perpetrated violence. Gay men, who are considered effeminate, are also considered incapable of aggression (Duke & Davidson, 2009). Oskarsson and Strand (2021) noted that this also makes it difficult to see male IPV victims. Because of expectations associated with masculinity, we assume men can prevent victimization by being strong enough to defend themselves. Even when acknowledging women perpetrators and male victims, we minimize the impact with the myth of mutual combat or the belief that queer relationship violence is less severe because the combatants are equal in physical strength and share responsibility for violence. Mutual combat also promotes the falsehood that when same-sex IPV occurs, it is egalitarian meaning that it involves aggression by both partners and is the result of trying to resolve relationship conflicts (Duke & Davidson, 2009). Respondents rate male-on-male violence as the least severe compared to male-­ on-­female violence. Lesbian partner violence was also rated as less serious than male-on-male violence (Russell et al., 2015). A sample of shelter workers were less likely to perceive a lesbian as an IPV victim although this varied by the type of abuse, with physical violence considered more serious (Basow & Thompson, 2012). Crisis center staff also believe it is easier for same-sex victims to leave their partners (Brown & Groscup, 2009). Rollè and colleagues (2018) argued that service providers and law enforcement perceive same-sex IPV both as less likely to become worse over time and less serious. Victims rate crisis shelters and law enforcement as less helpful than informal sources of support like friends and family (Edwards et  al., 2015). Although attitudes are slowly shifting, domestic violence program providers continue to see IPV as a “male perpetrated, heterosexual experience” (Ard & Makadon, 2011, p. 93). The persistence of these attitudes renders service providers as less effective in serving the queer community (Oringher & Samuelson, 2011; Oskarsson & Strand, 2021). There is evidence that some victims have internalized this myth. Compared to heterosexuals, queer persons are less likely to seek help after experiencing violence and assume service providers will blame them (Richardson et al., 2015).

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In my review of same-sex, sexual IPV (Waldner, 2021), I noted gendered definitions rendered sexual abuse as invisible. Adherence to stereotypes of gay men as promiscuous results in not seeing gay men as sexual assault victims (Todahl et al., 2009; Waldner-Haugrud, 1999). When sexual activity is gendered and only defined as penetrative sex, lesbians are not perceived as potential victims or perpetrators. This is not a positive view of lesbians. Rather, it is rooted in the belief that real sex only happens when you have a man with a penis and real rape needs that and an unwilling victim. As Girshick (2002) explained “to admit that womento-women sexual violence exists means to accept that women engage in sexual behavior with other women” (p.  1502). These myths are intertwined and interconnected and reinforce the notion that same-sex IPV is not worthy of research attention and that incidents should not be taken seriously by service providers. In addition to queer violence myths, there is a reluctance to air “dirty laundry” about IPV lest this should detract attention away from anti-gay and trans violence and discrimination (Turell et al., 2012) or reinforce beliefs that queer relationships are inherently more dangerous and abnormal (Baker et al., 2013; Bornstein et al., 2006; Duke & Davidson, 2009; Rollè et al., 2018) or reinforce media stereotype of trans persons as violent (Barrett & Sheridan, 2017). In my own work, I have written about conversations I have had with leaders of queer organizations who were reluctant to assist me with sample recruitment because they were afraid my research findings would portray the queer community negatively (Waldner, 2021). While I assured everyone that I was not interested in further stigmatization of the queer community and believed my research would be helpful, I had neither recognized nor understood that I would have no control over how others used my research. These community leaders were right to be wary of assisting me as Christian right websites and media outlets cherry picked results and misused my findings to portray lesbian relationships as dangerous (e.g., see Rich, 1998).

Methodological Issues Same-sex IPV research is hampered by several methodological challenges that can be divided into three broad categories including sampling, research design, and measurement. The lack of representative samples is considered the most significant challenge facing those who do same-sex IPV research (Murray & Mobley, 2009). The overreliance on convenience samples and the lack of robust representative sampling (Badenes-Ribera et  al., 2016; Burke & Follingstad, 1999; Finneran & Stephenson, 2013; Kim & Schmuhl, 2021; McCarry et al., 2008; Messinger, 2014; Oskarsson & Strand, 2021; Pimentel, 2015; Stephenson et al., 2011; West, 2002) have often resulted in small and non-representative samples comprised of young queer people residing in urban areas. Research samples also lack race, class, and educational diversity with respondents identifying themselves as mostly White, middle-class, and highly educated (West, 2002, 2012). Others have noted that

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convenience sampling strategies of using gay networks or venue sampling (e.g., bars, pride festivals, etc.) have yielded younger, more politically active, and more out respondents (Messinger, 2014). Others concur adding that samples obtained through lesbian, gay, and bisexual centric venues result in respondents who, in addition to being young and urban, are more likely to drink, be extroverted, and lack a consistent sexual or romantic partner (Burke & Follingstad, 1999), all of which have implications for the external validity of IPV research. While convenience sampling is criticized, researchers recognize the difficulty and expense in gathering random samples of same-sex individuals. For example, one study contacted 50,000 individuals to yield a queer sample of less than 1000 (Messinger, 2014). Bisexuals, trans, and other gender non-conforming individuals are often not the focus of research and are underrepresented in samples. Gay men are also less of a focus compared to lesbians (Callan et  al., 2021). Guadalupe-Diaz and Jasinski (2017) argued that the difficulty in obtaining sufficiently sized trans samples has led to excluding trans individuals from queer samples or just folding these experiences into lesbian and gay samples by either offering only binary gender categories in survey responses (Calton et al., 2016) or aggregating transgender respondents with others. This prevents discovering what might be unique about transgender IPV (Barrett & Sheridan, 2017). When transgender individuals are included, there is tendency to only focus on specific subpopulations such as individuals involved in sex work or to not differentiate between violence perpetrated by a partner and a stranger (e.g., hate crime) (Barrett & Sheridan, 2017). Research design issues include the overreliance on cross-sectional studies (Finneran & Stephenson, 2013), a lack of comparison between same-sex and heterosexual respondents (Edwards et al., 2015; McCarry et al., 2008), and the lack of perpetration studies. The reliance on cross-sectional studies makes it difficult to determine whether variables are causal or merely correlational. The inability to compare heterosexual and same-sex responses using consistent definitions of IPV within a single study makes it difficult to determine with certainty which groups are at a greater risk for IPV. The bias toward victimization studies means we do not have good information on perpetration (Finneran & Stephenson, 2013; Girshick, 2002; Waldner, 2021). Measurement quality issues are prevalent in same-sex IPV research (Kim & Schmuhl, 2021). First, there is the lack of consistency in how basic concepts are being defined including sexual orientation (Baker et al., 2013; Oskarsson & Strand, 2021), same-sex couples (Kim & Schmuhl, 2021), and IPV (Oskarsson & Strand, 2021; McCarry et al., 2008; McLeod et al., 2018). Gender and sexual orientation are often conflated (Laskey & Bolam, 2019) and not treated as separate variables that do not always overlap (Baker et al., 2013). As Calton and associates (2016) argued, “it is possible for someone to identify as genderqueer and be involved in a heterosexual relationship” (p. 588). The Stonewall Health Briefing (2012) found that of those lesbians or bisexual women who have experienced IPV, two-thirds reported the perpetrator was another woman leaving one-third perpetrated by a male partner. Gay and bisexual men reported experiencing abuse from both male and female partners. Freedner and colleagues (2002) reported that half of the adolescent lesbians

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reported abuse by a male partner and bisexual respondents reported being abused by both. Others have also demonstrated that sexual minorities report being abused by both male and female perpetrators (Blosnich & Bossarte, 2009; Langenderfer-­ Maugruder et al., 2016). The failure to ask about the gender and sexual orientation of the perpetrator and making assumptions “may be adding considerable confusion to the data collected” (Baker et al., 2013, p. 184). Given the larger degree of variation in the sexual orientations of transgender persons (Barrett & Sheridan, 2017), experiences with IPV cannot be captured by researchers who are focused only on same-sex relationships. A related issue is the inconsistency in how sexual orientation is used. Some researchers use the phrase sexual minority to be inclusive of lesbians, gays, bisexuals, transgendered, queer, and non-binary individuals while others only mean gay and lesbians (Oskarsson & Strand, 2021). Additionally, there is often the conflation of identity and behavior. Being involved with a same-sex partner (e.g., men having sex with men) is different from identifying as queer (Badenes-Ribera et  al., 2016; Finneran & Stephenson, 2013); thus, the dynamics of violence may be different. There is also a lack of consistency in how violence is defined and measured (Badenes-Ribera et al., 2016). For example, physical victimization may also include forced sex but that is not always the case. Sexual violence abuse might just focus on forced penetration or may cover a spectrum of coercive behaviors and outcomes (Waldner, 2021). Researchers use a variety of ways to measure violence from single items with dichotomous yes/no responses to measures with multiple items (Calton et al., 2016) making it difficult to compare results across studies. Another area of definitional difference is around the time frame studied. Research that looks at lifetime prevalence rates reports more IPV than studies that focus on the last 6 months or the most recent romantic experience (Calton et al., 2016). The use of wide recall periods may also influence prevalence rates (Finneran & Stephenson, 2013). Even when researchers use standard multi-item measures like the Conflict Tactics Scale, it is not used consistently across studies (Laskey et al., 2019). For example, some studies use the entire Conflict Tactics Scale while others use some of the subscales. There are also inherent difficulties with taking a measure and adapting it to a new population. Measures designed for heterosexual and cisgendered persons do not capture the unique ways of victimizing queer persons such as focusing attention on body parts that create discomfort or shame (Barrett & Sheridan, 2017; Laskey et al., 2019) or threats of “outing.” These queer relationship dynamics have been identified by previous research but are not well understood (Calton et al., 2016). Some researchers have called for the use of more inclusive language by reframing abuse as conflict and control (Laskey, 2021) or using the phrase relationship problems rather than the stigmatizing phrase “domestic violence” (McCarry et al., 2008). This might be important for queer respondents who are fearful of adding to the stigma already associated with being queer by admitting to IPV (Baker et al., 2013).

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Another measurement pitfall is failing to screen out heterosexual and childhood abuse experiences. Failing to exclude is both a failure to define the study population and a measurement issue. The target population in same-sex IPV tends to be either those who have ever been involved in a same-sex relationship or sexual minorities who have ever been involved in IPV regardless of whether the relationship is same-­ sex or heterosexual (Messinger, 2014). If we are trying to estimate the prevalence of same-sex IPV and identify risk factors, there needs to be a concerted effort to differentiate IPV that occurs in a same-sex relationship from that occurring in other types of relationships (Baker et  al., 2013; Rothman et  al., 2011; Waldner, 2021; Waldner-Haugrud, 1999; Waldner-Haugrud & Gratch, 1997). One method of screening is identifying both the gender identity and sexual orientation of the perpetrator. Most IPV surveys do not measure either (Baker et al., 2013). The varying multiple realities of queer experiences add a level of complexity to same-sex IPV research not encountered by those studying heterosexual couples and families. First, queer individuals often have a heterosexual history prior to coming out and even after coming out, sexual identities and behavior may be more fluid with some queer individuals choosing to have heterosexual encounters. Researchers have assumed that IPV reported by those identifying as queer was perpetrated by a same-sex partner. Researchers studying IPV also have not always screened out violence committed by non-partners including roommates, parents, or siblings (Langenderfer-Maugruder et al., 2016), or strangers (Barrett & Sheridan, 2017).

4 Theoretical Perspectives The lag in same-sex IPV research hinders the development of same-sex theoretical models, which is a barrier to understanding queer experiences (Calton et al., 2016). Theoretical and conceptual frameworks designed to understand heterosexual IPV may not be adaptable to same-sex IPV (Reuter et al., 2017), especially if there is something unique to the queer IPV experience (Burke & Follingstad, 1999). A review of same-sex IPV research published between 2008 and 2018 found that about 40% of articles did not use any theory or theoretical concepts. Of those that did, minority stress (30%) and feminism (18%) were the most frequently utilized (Kim & Schmuhl, 2021). While not a comprehensive assessment, I briefly review four theoretical perspectives that have been used for understanding same-sex IPV including social learning, a disempowerment perspective, feminism, and minority stress. A social learning perspective on IPV posits that violence is a learned behavior and that the persistence of IPV in adult relationships is the result of being exposed to childhood violence and abuse (McRae et  al., 2017). As previously discussed, childhood sexual and physical abuse as well as witnessing parental domestic violence increases IPV risk (Kim & Schmuhl, 2021; McRae et  al., 2017). A

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disempowerment perspective draws on social learning theory while bringing in other factors that are hypothesized to increase risk. Specifically, disempowerment perspective focuses on three different types of factors that increase risk of perpetration or victimization including individual characteristics, family of origin, and intimate relationship characteristics. The individual factors are personality characteristics including self-esteem and attachment. Family of origin characteristics encompass both social learning factors and other characteristics that increase vulnerability for same-sex IPV. Like social learning theory, the disempowerment perspective posits that those exposed to abuse as children may use violence as a means of coping with conflict. Other non-social learning factors important in understanding same-sex IPV include parental homophobia. The latter may reinforce internalized homophobia and possibly increase the vulnerability of a partner in two ways: estrangement from the family of origin and increased vulnerability to threats of outing. Intimate relationship characteristics are factors that increase vulnerability to IPV. McKenry et al. (2006) cite factors such as emotional dependency among lesbian couples, disparity in resources such as income, differences in physical size, job prestige, or physical attractiveness. These factors do not support social learning theory but do support a disempowerment perspective that combines both social learning and non-social learning factors. Feminist theory “has proved invaluable in unveiling the patriarchy present in domestic relationships and de-normalizing men assaulting their wives” (Cannon & Buttell, 2016, p. 668), but gendered definitions of victim and perpetrator makes it more difficult to recognize and identify abuse occurring within queer relationships (Bornstein et al., 2006; Calton et al., 2016). As a gendered theory, traditional feminism is not well suited for understanding same-sex power dynamics. Feminism “cannot help us understand why a femme lesbian abuses her femme lesbian partner…how can we understand the bisexual woman…who is abused by her female partner and abuses her male partner?” (Cannon & Buttell, 2016, p. 67). Rollè and colleagues (2018) argued that feminism has evolved with a focus on understanding how people are socialized to use violence in cultures that approve of violence to maintain authority. A post-structural feminist approach modifies traditional feminism by positing that we cannot assume women are powerless and that men always wield power. The incorporation of intersectionality has brought attention to how race, social class, and other identities intersect with gender to create systems of dominance and oppression. Thus, a post-structural approach allows us to acknowledge that lesbian partners may use violence as a means of control but how their social location differs from a heterosexual male perpetrator provides a context for viewing this violence differently (Cannon & Buttell, 2016). The minority stress model has been applied to same-sex IPV (Carvalho et al., 2011; Edwards et al., 2015; Freedner et al., 2002; Reuter et al., 2017) and focuses on having a stigmatized identity and other stressors given the marginalization of queer people. Having a minority status in an environment where social and institutional structures favor the majority increases stress and the likelihood of negative health outcomes (Reuter et al., 2017). Meyer (2003) argued that stigma is an important factor and managing this creates stressors that are unique to a minority group.

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Examples of stressors relevant to queer persons include internalized homophobia, discrimination, and stigma consciousness (Langenderfer-Maugruder et al., 2016) or not wanting to reinforce stereotypes, which is a burden unique to marginalized persons. Stressors can be both internal (homophobia) and external (e.g., anti-gay violence, discrimination).

5 Future Directions Much more research is needed to understand the dynamics of violence in queer families. Several researchers have made recommendations for research going forward. First, a research focus is needed on sexual minority couples and families (Kim & Schmuhl, 2021) and especially trans individuals (Walker, 2015) and bisexuals (Calton et al., 2016). Second, theoretical frameworks need to be developed and tested with empirical research on sexual minorities (Calton et  al., 2016; Kim & Schmuhl, 2021). Third, use high-quality instruments for measuring IPV and related concepts (Kim & Schmuhl, 2021). Fourth, design instruments that are based on the unique experiences of sexual minorities (Kim & Schmuhl, 2021). Fifth, deal with the challenge of representative sampling by forming research  partnerships with those who use representative sampling in their  heterosexual domestic violence research. Helping those researchers adopt language inclusive of same-sex experiences could yield more representative data (Murray & Mobley, 2009). Sixth, increase the number of longitudinal studies to assess causality so that we may develop empirically based IPV prevention techniques (Kim & Schmuhl, 2021). Seventh, increase the racial and ethnic diversity of samples. Most studies report overwhelmingly on White samples meaning we do not know much about victimization experiences of sexual minorities who also identify as persons of color (West, 2012; for an exception see Turell, 2000). Research on heterosexuals demonstrates that African Americans, Hispanics, and Native Americans are at higher risk for experiencing IPV (West, 2012). Finally, we need to know more about the dynamics and risk factors of psychological abuse. It is the most common abuse form but the least likely to be investigated (Laskey et al., 2019).

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Chapter 5

Adolescent Perpetrators of Violence and Aggression Towards Parents Hue San Kuay, Azizah Othman, and Paul Alexander Tiffin

1 Terminology and Definitions Adolescents’ aggression within the family is not a new phenomenon. Since being acknowledged as a potentially serious form of aggression over 60  years ago (Simmons et al., 2018), numerous studies have since been conducted to examine the factors which may contribute to the risk of family aggression by young people. Aggression perpetrated by young people towards the family is included in the definition of domestic violence in some countries. For instance, the United Kingdom (UK) Home Office defined domestic violence as ‘any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This includes (but not limited to) psychological, physical, sexual, financial and emotional abuse’ (Home Office, 2015, p.  3). This also means that domestic violence, from this definition, includes aggression and violence between spouse or romantic partners, aggression/violence between siblings aged over 16  years old and aggression/violence from children aged over 16 years towards parents. This definition, however, did not include perpetrators of parent-directed aggression or sibling aggression from those under the age of 16 years, although this can be a serious matter of concern. It may also contribute to a lack of data in national census or police records on cases involving those that did not fall under these categories due to the perpetrator(s) being underage. This is true in the UK, where cases of parent- and sibling-directed aggression are usually recorded only when these young people are referred to Child and Adolescent Mental H. S. Kuay (*) · A. Othman Universiti Sains Malaysia, School of Medical Sciences, Kubang Kerian, Malaysia e-mail: [email protected] P. A. Tiffin University of York, York, UK © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 P. Sturmey (ed.), Violence in Families, Advances in Preventing and Treating Violence and Aggression, https://doi.org/10.1007/978-3-031-31549-7_5

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Health Services (CAMHS). Another way for the cases to be identified is through relevant research studies, which also may not be able to capture all cases. The most neglected area of family aggression is aggression towards parents, at least until recently (Kuay & Towl, 2021; Wilcox, 2012). Child aggression or violence towards parents has been defined as ‘any act of a child that is intended to cause physical, psychological or financial damage to gain power and control over a parent’ (Cottrell, 2001, p. 3). This means the action may include any physical attack by the young people with or without the use of a weapon, manipulating emotion of the family members, being verbally abusive and taking or damaging personal properties of the family. In this chapter, however, we will be focusing more on child to parent aggression and violence.

2 Risk and Protective Factors Aggression and violence towards parents can be present in various ways. The most common forms are physical abuse and verbal threats, which may also include controlling and coercive behaviour towards the parents to the point that parents feel trapped and helpless (Cottrell, 2001; Harbin & Maddin, 1979). In the United States, a prevalence range of 7 to 29% was reported for physical violence towards parents (Kennair & Mellor, 2007). In Europe, a prevalence range of between 5 and 21% was reported in Spain for physical abuse and about 33 to 65% for verbal or psychological abuse (Calvete et  al., 2011, 2013a, b; Ibabe & Bentler, 2016; Izaskun Ibabe et al., 2013; Pagani et al., 2004). Some have argued that parent-directed aggression tends to be unreported because parents are ashamed and feel responsible for the child’s behaviour (Kennair & Mellor, 2007; Margolin & Baucom, 2014). Others were worried that reporting the child will heighten their children’s abusive behaviour (Perez & Pereira, 2006). Parents were worried that others will judge their parenting skills negatively if they seek help (Kuay & Towl, 2021). Similar to victims of spousal violence, parents might not realise they have become victims of their own child’s aggression and violence, while some find ways to normalise the child’s abusive behaviour (Gallagher, 2008). As a result, often only the household members or very close family know about the parents’ experiences of living with a violent child (Martínez et al., 2015).

Age Based on the World Health Organization (WHO) definition, adolescents refer to those aged between 10 and 19 years old (World Health Organization, 2014). Most studies on child-to-parent aggression tend to restrict the age of the perpetrators to 13–19 years old; however, the evidence shows that on average, young people tend

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to be involved with the criminal justice system by the age of 15 years (Nowakowski & Mattern, 2014; Strom et al., 2014). This was later further supported by Simmons et al.’s (2018) review which found the prevalence peaked during mid-adolescence and decreased as the adolescents grow older. These findings applied to various groups, including community, adjudicated and clinic-referred sample. Although the prevalence peaked around mid-adolescence, parents reported that their child begins to show aggressive behaviour as early as five years old, while to some, their children did not show any violence or aggression until they were 12  years old (Holt, 2016). Moffitt (1993) found that early onsetters begin their aggression journey earlier in life and their aggression will persist to adulthood, whereas late onsetters start to show aggression during adolescence but often desist when they are adults. In the United States, the FBI’s National Incident Based Reporting System showed that majority (51%) of home violence perpetrated by juveniles targeted parents, while 24% was directed towards siblings (Snyder & McCurley, 2008). In terms of age groups, among juvenile offenders (those aged between 13 and 15 years old), approximately half of those were charged for aggression towards parents, in comparison to approximately 20% of older offenders aged between 18 and 24  years who were charged for the same offence (Snyder & McCurley, 2008). This shows that aggression and violence directed towards parents is a relatively common problem, deserving more attention from academics and practitioners. An earlier study on high school and college students in the United States found that between 60 and 80% were victims of sibling aggression (Goodwin & Roscoe, 1990; Hoffman et  al., 2005). Among the clinic-referred samples parent-directed aggression was more likely to occur than inter-sibling aggression (Kuay et  al., 2016). In a further example, social services in London recorded 1892 cases of aggression by child towards parents where the perpetrators were 13–19 years old (Condry & Miles, 2014). Other previous studies estimated the rate of child to parent aggression to be between 5 and 21% among the community samples (Browne & Hamilton, 1998; Calvete et al., 2013a; Cornell & Gelles, 1982; Elliott et al., 2011; Ibabe & Jaureguizar, 2010). On the other hand, data on violence within the family, as reported to the police in Australia, indicated that 1–7% of instances were perpetrated by adolescents towards their parents (Moulds et al., 2019). Based on the data derived from studies in Canada, UK and Australia, it was estimated that one in 10 parents would have experienced aggression or violence from their children (Howard, 2011).

Gender A number of studies have reported no statistically significant gender differences in the tendency of perpetrating violence towards parents, among clinical and community samples (Nock & Kazdin, 2002; Pagani et al., 2004; Paulson et al., 1990). However, some studies found boys to be more likely to perpetrate aggression

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towards parents (60–80% perpetrators were boys) (Kennedy et al., 2010; Gallagher, 2008; Routt & Anderson, 2011). For example, Beckmann et al. (2021) conducted a study on 6444 high school students in Germany and found that female participants perpetrate more verbal aggression towards their parents compared to male participants, but no differences were reported for physical aggression. In a community sample study, Boxer et al. (2009) found more males perpetrated aggression towards parents compared to females, although some community sample studies found no significant gender differences for either types of violence (Calvete et al., 2013b; Margolin & Baucom, 2014). Furthermore, past studies included psychological violence (i.e. emotional abuse which may include the perpetrator controlling, shaming, humiliating, accusing and blaming the parent-victim). Females were found to perpetrate more verbal or psychological violence than males, while males tend to perpetrate physical violence than females (Calvete et  al., 2013a; Ibabe & Jaureguizar, 2011). The gender of the victims also differed, with mothers showing more tendency to be abused by their children compared to fathers (Kolko et al., 1996; Walsh & Krienert, 2007). For example, a study in Spain found that out of 413 cases, 97% of them involved aggression directed towards mothers (Ibabe & Jaureguizar, 2010). Some have argued that mothers are more likely to be victims of child abuse because mothers tend to be the leader for most single-parent families, and so they tend to be victimised simply because they are available. However, mothers are also more likely to be victims in two-parent/intact families, which show that mothers are more likely to be victimised compared to fathers regardless of whether the family is a two- or single-parents family (Pagani et al., 2003). However, being a single-parent often means mothers do not have another adult person to help stop their child from acting aggressively towards them (Beckmann et al., 2017). Control theory also suggests that single-parent or non-intact families are less likely to have basic bonds among the family members. Unlike intact families who tend to be equipped with norms and values and traditional activity patterns, non-intact families have previously been reported to be lacking in these elements (Gottfredson & Hirschi, 1990; Hirschi, 1969). Despite the idea coming from decades ago, it is still applicable in the recent context. For instance, Walker et al. (2007) found association between parental attachment with lower level of involvement in violent behaviour among Latino adolescents, which confirmed that Hirschi’s earlier theory is still relevant to explain the elements of family relationship as explained by the control theory. Moreover, in their recent publication explaining risk and protective factors towards child to parent violence, Beckmann et al. (2021) included Hirschi’s control theory to explain the decreased control capabilities in one-parent families.

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Parenting Styles One of the most influential theories on parenting styles was introduced by Baumrind (1967). She identified three preliminary parenting styles which are authoritative parenting, authoritarian parenting and permissive parenting. Baumrind’s parenting styles can be further divided into positive and negative styles. Positive parenting refers to a parenting style characterised by warmth, supportive and good parental monitoring. This is important for developing prosocial/altruistic behaviour among young people (Baumrind et  al., 1991; Beckmann et  al., 2021). Although parental monitoring was unrelated to aggression towards parents, parental warmth does matter. For instance, Beckmann et al. (2021) reported that girls who experienced warm parenting styles were less likely to direct their aggression towards their parents. Parental warmth can reduce aggression among children, and, more generally, help young people in building emotional attachments and learn to understand and respond appropriately to other’s distress cues (Dadds et al., 2014). Thus, parental warmth is the protective factor towards parent-directed aggression by children. On the other hand, negative parenting styles include permissive parenting, harsh parenting and neglectful parenting. Routt and Anderson (2015) highlighted that harsh parenting is the strongest predictor for aggression among young people. Authoritarian parenting, which can be characterised by imposing excessive control and corporal punishment on the child (Contreras & Cano, 2014; Gallagher, 2004), correlates with higher levels of reported verbal aggression towards fathers (Suárez-­ Relinque et al., 2019). Beckmann et al. (2021) also reported that parents who were physically and verbally violent towards their children when their children were younger and were more likely to engage in subsequent physical and verbal violence from the children towards parents in return. This was true for both sexes. Young people’s tendency to aggression and violence can be inherited from their parents (Asherson & Cormand, 2016). However, the way they are nurtured also plays a vital role to shape their behaviour, as explained by social learning theory (Bandura, 1977) since we learn to behave by watching how others behave. The behaviour will be imitated if we observed that the person’s behaviour is reinforced. So, growing up around parents and family members who are affectionate and practice positive communication promotes more prosocial behaviour and lower level of aggression among children (Ibabe & Bentler, 2016). Moreover, genome and environment seem to synergistically interact to give rise to antisocial dispositions, for example, in the case of the so-called ‘warrior gene,’ coding for variants in monoamine oxidase A (Buades-Rotger & Gallardo-Pujol, 2014). Harsh parenting, however, may not always contribute directly to aggression towards parents, especially when the child involved has heightened levels of psychopathic traits (Kuay et al., 2017). Contrastingly, for those children with high psychopathic traits, parents who practice permissive parenting styles will give the child an idea that they can control the parents to get what they want or to do things their own way. In other words, children with psychopathic traits may learn to use

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aggression instrumentally to make their parents comply to their requests. Calvete et al. (2014) suggested that parents who are permissive tend to raise their children to be immature, lack responsibility and more likely to be engaged in antisocial behaviour. In contrast, Bornstein (2002) indicated that those with neglectful parents are more likely to lack discipline, be more emotionally withdrawn from social situations, tend to play truant and get involved with delinquent behaviour. Furthermore, Suárez-Relinque et  al. (2019) found that among the different types of parenting styles that relate to parent-directed aggression by children, young people who receive authoritarian parenting score highest on their parent-directed aggression score, while those who received neglectful parenting score second highest. The relationship between parenting styles and aggression in teenagers is not linear. Parents have to modify their styles to fit a child’s temperament and the current situation or presenting behaviour. For instance, when the child uses violence, parents should not use physical coercion to retaliate. What has shown to help is learning methods to deescalate the situation, for instance, by using Omer’s (2004) non-violence resistance method. This method will be further discussed in the intervention section below.

Co-existing Mental Health Issues Kuay et al. (2016) conducted an audit of CAMHS clinical case files and found that among adolescents who presented with aggressive behaviour, the majority directed their aggression towards their parents and fewer directed their aggression towards their siblings. Kuay et al. (2021) later found that within an online community sample of parents, less than half of the participants reported to have experienced physical aggression from their children. In contrast, among young people attending a school for students with social, emotional and behavioural difficulties, 86% reported having perpetrated aggression towards their fathers and 95% towards mothers (Kuay et al., 2021). This suggests that young people who may reach the criteria for at least one mental or developmental disorder are more likely to be aggressive towards their family members. This can be due to their inability to regulate their emotion or affect and problem in controlling their impulses (Cottrell & Monk, 2004; Nock & Kazdin, 2002). In other words, they have trouble with social and emotional information processing. In an attempt to explain this, Crick and Dodge (1994) explained that aggressive and non-aggressive young people differ in their information processing. For instance, if a young person who is prone to aggression is faced with an unclear social situation, they will go through several cognitive steps before they react with aggression. They tend to pay attention to indicators associated with hostile intent, assume that others have hostile intention towards them, choose revenge goals and tend to believe that acting aggressively will bring them positive outcome (Calvete et al., 2015). On one hand, aggressive young people are more likely to interpret cues in a negative way and treat them as threats. For instance, they can react to parents

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simply asking where they are going – interpreting their parents’ intentions as controlling behaviour. On the other hand, non-aggressive young people will interpret the same question as their parents being concerned about them. In many countries, there are child and adolescent mental health services which take the lead on assessing and managing young people with mental health difficulties, neurodevelopmental disorders and behaviours that challenge. The standard procedure for a case of aggressive child will be an initial assessment by a relevant and appropriately experienced and qualified professional. These can include social workers, specialist teachers, educational or clinical psychologists, mental health nurse or a psychiatrist. In the latter case, a diagnosis of one or more developmental or psychiatric disorders may be made (Ageranioti-Bélanger et al., 2012). A detailed assessment report should include a formulation of the problems. Such formulations should ideally make reference to predisposing, precipitating, perpetuating and protective factors identified (Kuay et al., 2021), in relation to the aggressive outbursts. It is vital that such formulations also consider the function of the parent to child aggression, in the context of the child-parent relationship and wider family dynamics. Assessments may also result in appropriate diagnoses. Together with the formulation, the findings of a comprehensive assessment will inform both a safety and management/treatment plan. For older children and adolescents presenting with more serious aggression, management plans often involve professions from multiagency teams, which could include social work, teachers, as well as mental-­health workers. In younger children, support can be offered and interventions may be carried out by community-based child health workers and educational specialists. In some cases, where a psychiatric disorder that is potentially amenable to pharmacotherapy has been identified, a treatment plan may include medication (e.g. stimulants for attention deficit hyperactivity disorder (ADHD). In some, relatively rare cases, increases in aggression may result, at least partly, from an emerging severe mental illness, such as psychosis, (e.g. mania), particularly in older adolescents. Such conditions are also likely to merit medical treatment, alongside psychosocial support. In this respect it is worth noting that patients diagnosed with psychiatric illness may be less likely to target strangers, in preference to family members (Noffsinger & Resnick, 1999). Though parents and professionals sometimes consider the use of sedating or anti-impulsive medications where they are encountering childbearing aggression, pharmacotherapy is unlikely to be of sustained benefit in the absence of a treatable psychiatric diagnosis. Generally, psychosocial interventions are the mainstay of treatment for child-to-parent aggression. Moreover, there is some evidence that young people who target their aggression towards their family members and others are more likely to have diagnosis such as depression, ADHD or emerging antisocial personality disorders (Coogan, 2014; Ibabe & Jaureguizar, 2010; Routt & Anderson, 2011). This finding was later supported by Contreras and Cano (2015) study where they also found that among their study sample who were aggressive towards their parents, the majority were diagnosed with psychopathological problems in comparison to those who committed other types of offences. The most common diagnosis among the parent-directed aggression perpetrators was ADHD, while those who

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did not direct their aggression towards their parents did not have a clinical diagnosis (Contreras & Cano, 2015). Apart from ADHD, children who are affected by an autism spectrum condition may also show heightened levels of aggression at times. Young people with autism have difficulties to communicate and show restricted or repetitive patterns of behaviour, interests or activities (American Psychiatric Association, 2013). Compared to typically developing young person, individuals on the autism spectrum may have more aggressive outbursts and self-injury (Fitzpatrick et al., 2016). Due to their cognitive inflexibility and difficulty with understanding social encounters, young people with autism could be driven towards inflicting violence by their heightened stress response in handling social situations (Kanne & Mazurek, 2011). The violence inflicted can be unintentional but injuries may still occur. Sometimes, they may perpetrate injury on others or themselves because they appear to need to have a repetitive or ritualistic behaviour (Reese et  al., 2005). Sadly, frustrated and distressed parents shared that they sometimes regret having had the child (Ludlow et al., 2012). This issue may be exacerbated by the fact that children affected by an autism spectrum condition usually have impairments in reciprocal social interaction and non-verbal communication, and some may express relatively little warmth and affection towards their caregivers at times (Orsmond et al., 2006). Another condition that may increase the risk of child to parent aggression is the presence of a global intellectual disability. This affects general mental abilities including their ability to reason, solve problems, plan, judge or learn academically or from experience (American Psychiatric Association, 2013). These issues can contribute to affected children having issues communicating and socialising with others, functioning in the school or work environment, and with personal independence. Similar to parents of children with other types of diagnosed mental or behavioural disorders, parents of a child affected by an intellectual disability may attribute the aggression to the condition, which in some cases may foster a tendency to minimise the problem and thus delay help seeking. Children with specific and global developmental disabilities also commonly experience sleep disturbance and agitation, which can contribute to irritability and aggressive behaviour (Kuay & Towl, 2021). Such behaviour is more often reactive, in retaliation to actual or perceived provocations (Ageranioti-Bélanger et al., 2012). These situations can be commonly addressed by conducting a careful functional analysis, to understand the antecedents and consequences of such aggressive outbursts. The findings from such an analysis can then be used to help both the child and caregiver change their behavioural patterns and responses that may be triggering and unwittingly reinforcing such behaviours that challenge (Delgado-Casas et al., 2014). This will be further discussed in the intervention section. Sometimes, the way people treat young people with a diagnosis of mental health problems might contribute to their violence and aggression. For instance, according to Stewart et al. (2007), parents (especially mothers) were more likely to apparently permit violent behaviour from their children who have a psychiatric diagnosis. In other words, most children who abuse their parents do have a diagnosis of mental illness. Furthermore, parents were less likely to talk about or go as far as reporting

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their experience of being victimised by their children. The reasons given were they feel that they must have done something wrong in parenting the child, or afraid of being blamed or misunderstood by mental health practitioners (Cottrell, 2001; Haw, 2010). This indeed has occurred in reality. For instance, parents who called the police after experiencing abuse from their child were told to be more strict. The outcome from a similar scenario will be replicated for cases involving perpetrators under the age of 16 (or under the legal age of criminal responsibility in many, though not all jurisdictions, such as England and Wales, UK where it is 10 years old). There is also another issue, where parents are responsible for the child if they are under age, they cannot leave the child or ask the child to leave, unless social services can arrange for foster family, or other respite carers, who are willing to take over the responsibility of parenting, at least temporarily.

Drug and Alcohol Use Past studies have shown that being under the influence of illicit drugs or alcohol could increase the risk of violence and aggression. This is especially true for longer-­ term drug and alcohol users compared to casual users (Petit, 2005). According to Holt (2016), young people who use drugs and alcohol will go through physiological changes that will directly impact their brain and behaviour. It will also affect their interpersonal relationship too, leading to increased family conflicts. The use of drugs and alcohol may be a source of tension and disagreement in families for a number of reasons, including their illegality, the effects on the mental and physical health of the young person, as well as the financial impact of both them, and sometimes their families. It is also common for young people to run up debts with the local dealer, who then may target family members and threaten them in an effort to receive payment. Parents have also shared that their child’s aggression become more intense when they took drugs or alcohol, and more likely to cause severe injuries to their victims (Cottrell & Monk, 2004; Haw, 2010). This can be directly due to the disinhibiting effects of intoxication, or unpleasant withdrawal effects when coming down from a high such as paranoia and irritability. Parent directed aggression can also be instrumental, in that it may have the goal of obtaining funds to be able to access and pay for illicit substances or alcohol (Calvete & Orue, 2016; Calvete et  al., 2020). Thus, it has become crucial to include questions regarding drugs and alcohol usage during assessment for young people who perpetrated aggression towards their parents.

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Lockdown In light of the coronavirus disease 2019 (COVID-19) pandemic, the governments in the majority of countries in the world made it compulsory for their citizens to go into lockdown or to stay at home, unless it is absolutely necessary to leave the house. Schools were closed and many who work for non-essential services were asked to remain at home. This may be seen as a luxury to some and also an opportunity to spend quality time with family members. However, to others, this has increased the occurrence of violence within the household – which not only include spousal violence and child abuse but also aggression directed towards parents. Evidently, an online survey conducted by researchers from United Kingdom between April and June 2020 found that 73 out of the 104 participants reported an increase in violence from their child during the lockdown period (Condry et  al., 2020). Moreover, home visits by statutory services, such as social care, may have been curtailed during the pandemic. This means signs of child to parent violence might be more likely to go undetected and reported.

3 The Effects of Violence and Aggression In this section, we will be sharing some case examples, based on those seen in practice. No identifiable details are given, and some key elements in the scenarios including names have been changed so that individual patients and families are not identified. From these examples, we will then discuss the effects of violence and aggression and suggestion for intervention.

Case I: An Adopted Child of a Single Mother Adam was an 11-year-old boy. Since birth, he was adopted by a single kindergarten (nursery school) teacher. His biological parents were casual workers and already had six children before him, thus the additional child placed considerable financial pressure on the family. Adam’s adoptive mother reported him as having difficulty with controlling his impulses with frequent aggressive outbursts. Recently, Adam started throwing heavy and sharp objects such as chairs and rocks at his mother when things did not go his way, or when he got upset. Adam’s aggressive behaviour was a long-standing issue. His mother claimed he had used sharp items such as knives and scissors to threaten others to comply to his wants, since he was six. Following that, Adam displayed many episodes of violent behaviour especially when his wishes were not fulfilled. He lashed out at his mother’s property, for example, scratching her car and breaking the house’s windows. There was also an occasion when his aggressive behaviour was apparently unprovoked. During one

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incident, he pricked his six-year-old cousin’s penis with a needle during a sleepover and claimed he did that because he was curious to see the cousin’s reaction. Adam has had a long history of stealing, starting with taking money from his mother’s handbag to stealing money from the other teachers who worked with his mother. Subsequently, he stole debit cards from his mother’s colleague wallet and tried to use them for online purchases and physical transaction, for example, going to mobile shop to buy latest version of the iPhone. Despite questions and interrogation, he denied these actions even when his mother found the money in his room, or new things that he bought. Adam often created stories or manipulated others in order to cover the tracks of his stealing. On several occasions, his mother had to compensate others for the stolen money and had to bear the shame of apologising on Adam’s behalf. Adam’s stealing behaviour spiralled out of control when he stole money which were monthly school fees at the school. His mother and the other teachers had to report this to the police, whom Adam eventually admitted his offence to, because he was afraid to go to jail. Adam’s mother had brought him to a psychiatrist two years ago when he had been showing problems with impulse control and he was subsequently diagnosed with ADHD. However, he did not comply with the prescribed medication and his mother was unable to make him take it. Whilst his mother claimed that she tried to discipline the child and impose rules in the house, her efforts seemed ineffective. Instead, Adam’s mother felt helpless and a sense of losing control over the child, in addition to feelings of regret and guilt when family members kept asking why Adam behaved in that manner. She admitted to often being permissive to avoid the more harmful effects of Adam’s aggressive reactions. In order to help Adam and his mother, the team offered supportive counselling and provide her with information on how to de-escalate from Adam’s violent abuse by using non-violence resistance. The mother was advised to get a friend or close relative involved to support her through the intervention, as being a single mother can be quite an isolating experience at times. This would help support Adam’s mother in being consistent, even if there is an initial escalation in Adam’s behaviours that challenged (an extinction burst) as she got used to saying ‘no’ to unreasonable requests, consistently and in a calm manner. Adam’s mother also admitted being inconsistent in applying the learned skills. Adam was involved in non-directed and directed therapeutic play, which were also helpful in reducing his aggression and also seem to reduce his need to engage in stealing behaviour.

Case II: A Child with Chronic Illness Josh was a 12-year-old boy, who was diagnosed with diabetes mellitus type 2 with moderate diabetic ketoacidosis (DKA) two years ago. He inherited the disease from his mother who passed away four years ago due to complications of diabetes. Josh was the youngest of two siblings, and his elder brother was also affected by diabetes. However, Josh’s older brother was diagnosed at an earlier age and had already begun to get some of the complications of the condition due to non-compliance with

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medical treatment. Whilst having the potential to manage a treatable medical condition, Josh also did not comply with treatment and a diet plan, resulting in frequent, avoidable, hospitalisations to manage his blood glucose levels. Josh was referred to a health psychologist to help support him with treatment adherence, as well as to manage his angry outbursts, which he often displayed towards his stepmother, whom father has recently married. It was reported that when he got annoyed, Josh would throw and kick things around the house, such as chairs and tables. The stepmother claimed she was afraid that Josh’s externalising behaviours could be harmful to her, thus she gave up from trying to convince Josh to adhere to his treatment and diet plan. Josh’s father, being a busy businessman and contractor, resolved to getting assistance from the health psychologist. A series of behaviour modification approaches were planned and tried out with Josh, upon agreement with his father. This involved a reward schedule (positive reinforcement) for treatment adherence, though incentives would be withheld, if there were aggressive outbursts directed at stepmother. It has been more than a year now, and his therapist has attempted three phases of behaviour modification, yet there has been little consistent improvement in Josh’s behaviour, in terms of angry outbursts and diabetic treatment adherence. Although his therapist observed some positive changes at the beginning of the therapy. However, it was observed that Josh’s behaviour quickly reverted back to baseline once he had achieved a desired reward as part of the behavioural plan. After further analysis and reflection, it was identified that Josh was taking advantage of his father’s willingness to agree to all types of reward that Josh suggested, as long as Josh complied with the diet plan and treatment. At this young, primary-­school age Josh had obtained a new motorcycle, the latest version of an iPhone and an expensive set of video games. All this had been achieved from a reward management plan that he had only followed through, at most, for three months, with his behaviour quickly regressing after achieving these goals. It was also clear that his stepmother chose not to get involve in Josh’s diabetes care plan due to his externalising behaviour being perceived as intimidating and threatening to her. Josh’s father was willing to fulfil all Josh’s wishes for rewards because he said he can easily afford them but express the feeling that he still has limited control over his son’s behaviour. In order to further help the family, Josh was to be assessed using the Inventory of Callous-Unemotional Traits (Frick, 2004). If the results suggest the presence of a relatively low level of callous-unemotional traits, Josh can go on with the Step Up programme. This will help him acknowledge his behaviour and how it has been affecting his family members (i.e. build empathy and a sense of responsibility for his actions). However, if he is found to be relatively high on callous-­unemotional traits, the modified parent-child interaction therapy for callousunemotional traits is considered to be more likely to be helpful.

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Case III: The Boy with Limited Prosocial Emotion Jacob was a 15-year-old boy and the youngest of three siblings. His mother brought him to the attention of CAMHS, who then referred him to the Forensic Child and Adolescent Mental Health Services. Jacob’s parents were no longer together but his mother had a new live-in partner. Since he was young, Jacob disliked being kissed or hugged by his mother and would react negatively towards affection. His mother described him as ‘dead and cold like ice’. Jacob was very controlling towards his mother and would shout at her to make her do things for him. He is also very rude towards his mother’s partner. Despite not having an official diagnosis, Jacob’s mother said she had read about autism and ADHD and wondered whether Jacob had these conditions. For instance, on many occasions, Jacob would have an aggressive outburst around the house and punch holes in the walls, breaking doors and windows. On one occasion, Jacob wanted to go out late at night and his mother stopped him but got physically assaulted by Jacob. His mother’s partner managed to pull Jacob away from his mother and let Jacob go out for the night. Jacob sworer at his mother a lot and demanded money from her. He would also make suicidal gestures by tying a rope around his neck if he did not get what he wants. Jacob seemed to know that this will make his mother give in to his demands. Jacob’s aggression began when he was in nursery but it only peaked in recent years. His mother called the police a few times when he was lashing out in the house and threatening to kill himself. His suicidal behaviour, however, was seen by the police as a vulnerability (‘cry for help’), and the police took him away and locked him up to keep him safe, but no further actions were taken. Jacob’s mother even had to modify her parenting style to suit Jacob’s behaviour. She has never raised her voice towards her older children but only did so with Jacob and also argued with him. The mother said that due to Jacob’s behaviour and frequent tormenting of her, she herself is seeking help from a therapist for anxiety, depression and trauma. The mother was taught to use some elements from the non-violence resistance to handle Jacob’s behaviour, with the help from her partner. Jacob received therapy sessions from the clinical psychologist from the Forensic Child and Adolescent Mental Health Services and they helped him manage his angry outburst and self-­ regulated emotions more effectively using a dialectical behaviour therapy-skills framework (McKay et al., 2019). This included elements of mindfulness, to increase self-awareness, as well as problem-solving, interpersonal and communication skills. He has since built a trusting relationship with the psychologist and has responded to therapy. His physical aggression has significantly lessened in both frequency and intensity.

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Case IV: The Girl Who Drives Her Mother Crazy Delia is a 16-year-old girl, with two younger siblings (a sister, 13, and a brother, 5). She was referred to CAMHS for aggression towards her mother. According to Delia’s mother, when she could not get what she wants, there was a ‘war going on.’ Anything could be a trigger for her outbursts – for example, when her mother said her boyfriend could not come over, or when her mother requested her to help with simple house chores. Her violence spiralled out of control, to the point that her mother felt restless and constantly have to be extra careful, not to say anything wrong. Most of the time, Delia would be banging about, slamming doors and lashing out at things angrily around the house. She has punched her mother on the face and wounded her mother’s lips in doing so. She swore and shouted at her mother and was very controlling towards her, wanting to know her whereabouts at all times. On three different occasions, her mother called the police because she felt that her safety was in danger from Delia’s outbursts. On one occasion, the police took Delia away and locked her up in a police station cell overnight. Delia was also physically aggressive towards her younger sister. Her mother admitted that she modified her parenting style to fit Delia’s behaviour and situation, but most of the time, she was also verbally harsh, which was a response to Delia’s behaviours that challenged her. Delia’s mother felt that she was responsible for Delia’s behaviour and believes that her own anxiety and mental health issues contributed to Delia’s aggression. Delia’s brother was afraid of her and has episodes of night terrors. Consequently, the mother decided to send the boy to live with his grandparents, to keep him safe and hoping that she could spend more time with Delia to improve their relationship. However, that was ineffective and Delia’s behaviour did not consistently improve. Her mother tried to further improve things; thus, she followed the suggestion from the CAMHS and social services to try a relocation of care placement for Delia, who since then moved to live with her father. Delia’s father seems calmer and more consistent in his responses to Delia’s behaviours that challenged. Thus, Delia seemed more contained emotionally. This seems to reduce the intensity and frequency of Delia’s behaviours that challenged. After moving, Delia’s mother’s mental health has improved and Delia has also been working with a therapist to further reduce her problematic behaviour.

4 Assessment, Formulation and Interventions The cases that were presented above benefitted from assessments with the CAMHS team. There are other suitably qualified professionals that may be equally appropriate, depending on how local services are arranged. Initial assessment can include exploring relationship between the parent, child and the wider family and social environment. Structured instruments can also be helpful in complementing an assessment and providing some qualitative indicators about relative factors. For

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example, the Inventory of Callous-Unemotional Traits (Frick, 2004) can be used to estimate the presence of callous-emotional traits or the Child to Parent Aggression Questionnaire (Calvete et al., 2013a) can be used to quantify carer-focused aggression. Both assessments are available in self-report and parent-report versions, which can be requested from the developer. Interview questions for affected parents and families can include more specific questions to explore the experience of both previous and current aggression in the family. The interview schedule includes questions to understand the situation from the parent’s point of view, explore conflict and violent/aggression episodes, whether the police were contacted in relation to episodes of violence, exploring parenting styles used by the parents, asking whether they feel safe in their house with an aggressive/violent young person around and the type of support they have received or need from the professionals (Kuay & Towl, 2021). Particularly when a child exhibits relatively high levels of emerging callous-­ unemotionality, families may have the experience of multiple ineffective interventions. It is therefore important to give the family space to talk about their experience of previous interventions, and try and understand why these may not have been effective. It is important during assessment to counter any therapeutic nihilism generated by these previous experiences, whilst giving the family a realistic expectation of what might be required to improve carer directed aggression, and the outcomes that might be expected. In order to help the aggressive young person, their parents and immediate family members who are affected by the problem behaviour, intervention can be suggested to prevent future occurrence of violence episodes. Although there are different types of intervention which can be categorised into primary, secondary and tertiary intervention, our focus for this chapter will be on secondary and tertiary intervention, which is to help the young person who have been aggressive towards their parents (and siblings) and their family to ameliorate the problem behaviour and improve the quality of life and relationship among the family members.

 arent Management Training and Parent-Child P Interaction Therapy Parent management training (PMT) is an intervention that was developed to help reduce negative elements within the family, including children’s temper outbursts, violence and defiance towards parental requests. Loeber et  al. (2009) stated that children’s aggression and violence can happen due to multiple related factors including biological, environmental and psychosocial factors. PMT can help to reduce the risk factors by using Skinner’s (1938) behavioural operant conditioning principles. Based on these principles, a person is more likely to behave in a certain way if they learn from their previous experience that the outcome of that particular behaviour is rewarding. One example in this context is when a young person threatens his mother to let him drive the car or he will ‘punch her in the face,’ which

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resulted in the mother handing him the car key. The young person thus learns that threatening his mother will increase the chance of her giving him what he wants. The goal of PMT is for parents to increase their parenting skills by being consistent and using effective disciplinary approaches when the child demonstrates unwanted behaviours that challenge. This also includes guiding parents as to how to increase their competency in managing aggression in their children and ways to increase the children’s compliance with parental requests. This can be achieved by training parents to learn the potential predisposing factors and triggers for their children’s negative behaviour. Parents can then practice methods to safely ignore or otherwise respond to those behaviours in a way which increases the chances of positive responses and extinguishes negative behaviours. As part of the training, parents will also learn to communicate more effectively and use positive reinforcement (e.g. praise and reward) when the child project desirable behaviour (Sukhodolsky et al., 2016). In addition, once parents have mastered positive parenting strategies, they may also be taught punishment procedures. However, there has been debates on whether punishment is suitable, especially from western studies. The use of corporal punishment (physical chastisement) is generally viewed negatively by experts, and in many jurisdictions is now illegal. Therefore, the emphasis is on negative punishment rather than positive punishment. This can include the usage of time-out, removal of rewards and restricting privileges, which is generally found to be more effective than positive punishment per se, in shaping positive behaviours and extinguishing negative ones (Kazdin, 2005a, b). Although parents are the main participants in PMT intervention, they still have to practice their new skills on their children to know if it is effective for them (Eyberg et  al., 2008). Past studies found PMT to be helpful in preventing future antisocial behaviour, and it is especially helpful for the children under the age of 12. However, researchers have conducted randomised controlled trials for PMT intervention on those between the age of 2 and 17 years old and the treatment was effective in reducing disruptive behaviour among this wider range of age groups (Kazdin, 1997; Kronenberger & Meyer, 2001). There are different programmes under the label of PMT, including Helping the Non-Compliant Child, Incredible Years Training Series, Triple-P Positive Parenting Programme and the Parent-Child Interaction Therapy (Pearl, 2009). These programmes have been found to help parents and young people with behaviours that challenge, including aggression. However, studies have shown that the strategies were less effective if the young people with conduct problems also have higher level of callous-unemotional traits. Since young people with high callous-unemotional traits are less likely to respond to negative punishment, this strategy may be ineffective in reducing unwanted behaviours. Conversely, using reward-based strategies (i.e. reinforcement) may be more effective in this context (Forehand et al., 2014). In order to manage the cases involving children who are high on callous-unemotional traits, PMT programme, especially the modified Parent-child Interaction Therapy for Children with Callous-Unemotional traits (PCIT-CU) (Fleming & Kimonis, 2018), can be used. The PCIT emphasis on strengthening the attachment between the parent and child reward strategies, emotional warmth from parents and

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increasing positive quality in the parent-child relationship rather than using punishment to reduce problem behaviour (Kochanska & Thompson, 1997). For PCIT-CU, additional material is needed to address the emotional deficits in these children. The main component is to strengthen the attachment bond between the parent and the child. Parents learn positive parenting strategies such as descriptive praise, reflecting on their speech, imitating behaviour and describing them and expressing enjoyment (also known as the ‘PRIDE’ skills). The ‘enjoyment’ element was replaced with ‘emotional expression’ to enhance parental warmth in order to suit children with conduct problems, who are high on callous-unemotional traits. Parents learn to apply warmth and affection when parenting their child, and persevere even when the child did not respond to it initially or find it aversive (Fleming & Kimonis, 2018). PCIT can also be used by parents with older children by replacing the time-out protocol with a more diverse discipline strategy (Pearl, 2009).

Multisystemic Therapy Multisystemic therapy (MST) is an intervention developed to reduce antisocial behaviour in children and adolescents. This intervention is also applicable to young people convicted for sex offences, substance misuse and chronic physical illness. The fundamental of the MST came from the aspects of Bronfenbrenner’s (1979) social ecology theory. According to the main inference of the MST, adolescents involvement with antisocial activities are related to their family, peer, school and neighbourhood factors. Secondly, parents play the most important role for young people’s behaviour, so the MST intervention focuses on providing parents with knowledge and skills for effective parenting. During MST intervention, the therapist works with the effected family by using family’s strengths to overcome the weakness that can hinder parents’ effectiveness in parenting. For instance, having a strong social support can help parents who are feeling stressful and hopeless of having to handle their child with antisocial behaviour to persevere. Improvement in the family functioning will help improve young people’s functioning and encourage them to surround themselves with prosocial peers (Henggeler et al., 2009). Based on a systematic review analysing the efficacy of MST, all included studies showed clinically significant treatment effect post intervention (Tan & Fajardo, 2017). The improvement was significant in terms of reducing incarceration and delinquency (Borduin et  al., 2009; Henggeler et  al., 1992; Letourneau et  al., 2009) and sex-­ offending behaviour (Borduin et al., 2009; Letourneau et al., 2009). Most importantly, two of three found MST to help in reducing antisocial behaviour including aggression and non-compliant (Ogden & Halliday-Boykins, 2004; Weiss et  al., 2013). Therefore, it can be useful for families affected by child aggression towards the parents.

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Non-Violent Resistance Non-violent resistance is an intervention method developed by Omer (2004). It is a specific treatment plan to guide parents on how to manage conflicts with their child who have been targeting aggression towards the parents, especially at home. The main aim of the non-violent resistance intervention is to assist parents in increasing their authority in a more positive manner while also helping parents to develop strategies that are more workable in handling their child’s coercively controlling behaviour without making it worse, while returning harmony to the family (Kuay & Towl, 2021). The techniques include parents delaying their response, increasing presence, deescalating tense situation and include a close friend or family member as a support system to resist and control the child’s violent behaviour (Omer, 2004). As part of the intervention, parents will be equipped with the knowledge to handle the conflictual situation using a diplomatic and non-violent approach, rather than one that may also involve physical or verbal aggression from the carer to the child. In his book, Omer mentioned that the relationship between a parent and the child can improve the latter’s internal sense of security. This parent-child relationship will be modified when the child begins to expect their parents to show authoritative presence in their life (Coogan, 2018). Based on Omer’s definition, an authoritative parenting style is defined as ‘anchoring function in attachment which also protect the child by giving vigilant care’. Parents who go from being laid-back, lacking in warmth or harsh, to being restricting and resisting (authoritative) the child’s aggression and violence will lead to the child having emotional reservation when he/she internalise their parent’s more self-assured and confident presence. Importantly, as part of the process, parents will transition from weak to strong parenting. Despite experiencing aggression from the child, with this non-violent resistance method, parents can still continue being around the child to provide emotional closeness, while making the child understand that their parents are refusing to accept any further violence or aggression from them.

Step Up Programme Like the non-violence resistance programme, the Step Up intervention programme is also designed for families that are affected by their young and violent family members. Step Up is an acronym for Stop, Time out, Evaluate, Prepare, Use Skills and Patience. This 21-week intervention programme can be used to help violent young people between 14 and 17 years of age. This programme operates on four principles. The first is based on the restorative justice principle. This encourages the young person to learn how their actions affect their family, and they will aim to make amends for any harm or damage they have caused. In the second principle, the young person is guided to regulate their emotions by learning self-calming skills (e.g. meditation). In the third principle, the young person will learn to use a

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cognitive behavioural therapy approach to change their internal thought processes, beliefs and feelings. This would bring them the awareness of and insight into the incidents that occur between them and their parents and other family members (Kuay & Towl, 2021). The approach needs the young person to acknowledge the effect of their actions towards others. However, the aim of this programme is not to instil the feeling of shame among the perpetrators. Indeed, feeling ashamed could hinder them from showing empathy and cloud their ability to focus on their victims (Gilman & Walker, 2020).

5 Conclusion The main question that parents would ask themselves when they experience violence and abuse from their children is ‘Where do I seek help?’ According to Rutter (2020), for  parent/victim of child violence, school tends to be the first point of contact among parents who were victimised by their children. There is a strong possibility these young people would also be perpetrating aggression and violence in the school settings too. Thus, school may already be aware of the child’s tendency to aggressive behaviour, and may be able to relate to the parent’s experiences. We also would like to highlight that young people who use aggression and violence towards multiple people in multiple settings might be those that can be termed as ‘high in callousunemotional traits’. Based on the authors’ published trait-based model, young people with heightened level of callous-unemotional traits are lacking empathy, tend to use aggression to get their own way and disregard the feelings or suffering of others. They are also known as the generalists  – who will generalise their aggression towards anyone around them, parents, siblings, peers and teachers, as long as they can get what they want (Kuay et al., 2017). Although experts believe that home is where violence and aggressive behaviour begin, it is almost impossible to examine every household for the incidences of aggression from young people. One feasible approach to help us understand violence and aggression perpetrated by children and adolescents at home and other settings is by examining their behaviour in school (Eisenbraun, 2007). Finally, it is worth noting that young people that are deemed violent or disruptive are especially vulnerable and in need of assistance, as much as their family members who are affected by their violence and aggression.

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Chapter 6

Older Family Members: Victims and Perpetrators of Elder Abuse and Violence Karen A. Roberto

Older adults are frequently excluded from research focused on family aggression and violence. Yet, most abusive actions against persons aged 60 and older come at the hands of family members (Acierno et al., 2009). Conversely, older adults themselves may be the perpetrators of abuse, inflicting physical or psychological harm on their partners or acting aggressively toward their relatives and family caregivers. To shed light on victims and perpetrators of abuse in late life, the focus of this chapter is on abuse and violence perpetrated by family members toward older adults living in the community. With increasing attention to elder abuse as a global public health problem, numerous scientific reviews have synthesized the literature on issues surrounding abuse and violence in late life. Recent in-depth topical reviews relevant to this chapter provide insights about risk factors for elder abuse (Storey, 2020), perpetrators of elder abuse (Roberto, 2017; Teaster & Roberto, 2020), intimate partner violence (IPV) in late life (Crockett & Brandl, 2020; Gerino et al., 2018; Pathak et al., 2019), abuse of older women (Roberto & Hoyt, 2021), and abuse within older families (Bornstein, 2019) as well as elder abuse interventions (Ayalon et al., 2016; Burnes et al., 2021). Informed by these reviews and more recent scientific literature, this chapter begins with the epidemiology of elder abuse including definitions and terminology used to identify and study abuse, prevalence data on elder abuse nationally and internationally, and types of abuse. The next sections provide an examination of commonly identified individual and perpetrator characteristics and vulnerabilities that place older adults at risk for abuse and violence followed by a synthesis of current research on elder abuse perpetrated by family members and abuse perpetrated by older adults against family members. The final section addresses intervention strategies to prevent and respond to elder abuse. K. A. Roberto (*) University Distinguished Professor, Center for Gerontology, Blacksburg, VA, USA e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 P. Sturmey (ed.), Violence in Families, Advances in Preventing and Treating Violence and Aggression, https://doi.org/10.1007/978-3-031-31549-7_6

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1 Epidemiology of Elder Abuse Definitions of Elder Abuse There is not a universal definition of elder abuse used by researchers, helping professionals, or policymakers. The lack of a consensus definition creates inconsistencies in identifying what constitutes elder abuse, limits comparing and generalizing findings across studies, and prevents creating a common strategy for the development and evaluation of intervention programs. Definitions typically used in the research literature that have been put forth by the Centers for Disease Control and Prevention (CDC), The World Health Organization (WHO), and the National Research Council (NRC) are provided in Table 6.1. The common element across these three definitions is that all acknowledge that abuse causes “harm or loss to an older victim” (Anetzberger, 2012, p. 12). Terms such as “elder mistreatment” (Bonnie & Wallace, 2003), “elder abuse” (WHO, 2021), and “elder maltreatment” (WHO, 2011) often are used interchangeably and includes one or more forms of abuse: (a) physical abuse (use of physical force that may result in bodily injury, physical pain, or impairment), (b) sexual abuse (nonconsensual sexual contact of any kind), (c) psychological and emotional abuse (infliction of anguish, pain, or distress through verbal or nonverbal acts), (d) exploitation (illegal or improper use of an older person’s funds, property, or assets), and (e) neglect and abandonment (intentional or unintentional refusal or failure to fulfill any part of a person’s obligations or caregiving duties to an older adult) (National Center on Elder Abuse, n.d.  -b). IPV encompasses physical violence, sexual violence, stalking and psychological aggression (including coercive tactics) by a current or former intimate partner (Breiding et al., 2015, p.11); it is often conflated with other types of elder abuse, making it a less recognized form of elder abuse (Roberto & McCann, 2021). Polyvictimization, or the harm of an older person “through multiple co-occurring or sequential types of elder abuse by one or more perpetrators, or when an older adult experiences one type of abuse perpetrated by multiple others” (Ramsey-Klawsnik & Heisler, 2014, p.15) also occurs within Table 6.1  Definitions of elder abuse Organization Date Definition CDC 2021 An intentional act or failure to act that causes or creates a risk of harm to an older adult. An older adult is someone age 60 or older. The abuse often occurs at the hands of a caregiver or a person the elder trusts NRC 2003 Intentional actions that cause harm or create a serious risk of harm to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder, or failure by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm WHO 2021 A single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person Source: National Center on Elder Abuse (n.d.-a)

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older families. Throughout the rest of this chapter the term elder abuse will be used to collectively refer to elder mistreatment, maltreatment, and acts of violence or intentional harm against older adults unless otherwise noted.

Prevalence of Elder Abuse According to the World Health Organization (2021), approximately 16% of people 60 years and older living in community settings experienced some form of abuse every year. The number of elder abuse cases is projected to increase as many countries have rapidly aging populations. In the United States, elder abuse affects an estimated 10% of older adults annually (Acierno et al., 2010). The prevalence of elder abuse is likely underestimated because older adults are hesitant to report being abused to authorities, particularly when they are abused by a family member. They often do not report abuse because of shame, self-blame, fear of retaliation, or threat of nursing home placement (Roberto, 2017). Older victims may also feel sympathetic and protective of their family members, especially when codependence, substance abuse, mental illness, or a combination thereof are involved (Roberto et al., 2022). Estimates of prevalence of elder abuse vary by the types of abuse assessed, population examined, and methodological strategies used to identify cases of abuse. Among types of elder abuse reported by community-dwelling older adults in 28 countries, psychological abuse was the most prevalent (11.6%), followed by financial exploitation (6.8%) and neglect (4.2%); less prevalent was physical (2.6%) and sexual abuse (0.9%) (Yon et al., 2017). Prevalence studies have shown that between 15 and 30% of older women report IPV at some point during their life (Bonomi et al., 2007; Montero et al., 2013; Stöckl & Penhale, 2015). Incidence studies have shown that 8.6% of currently partnered women experienced IPV since turning age 55 (Zink et al., 2005); 3.5% of women aged 65 and older reported IPV in the past five years, and 2.2% in the past year (Bonomi et al., 2007); and 5.5% of women between 50 and 64 experienced IPV in the past two years (Sormanti & Shibusawa, 2008). In the United States, a national study of 5776 adults aged 60 and older, 1.7% of older adults reported experiencing multiple forms of abuse in the past year (Williams et  al., 2020). Physical abuse often occurs with other types of abuse (Weissberger et al., 2020). For example, in a study conducted in Brazil, physical and psychological violence commonly occurred together followed by financial abuse and neglect (de Lopes et al., 2018). Giraldo-Rodríguez et al.’s (2022) examination of the revictimization of older Mexican women in the United States found that of the 3185 women aged 60 and older who reported being abused in the last year, 81.0% had been revictimized, and 14.0% reported life time incidences of child abuse, IPV, and elder abuse. Elder abuse is thought to occur at similar rates across urban and rural settings, although few comparative analyses exist. Prevalence of elder abuse by geographic location is either not reported or researchers have focused on only one geographic

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area. For example, Soares et al.’s (2010) study of 4467 randomly selected women and men aged 60–84 living in seven urban areas in Europe found that 19.4% of the sample experienced psychological abuse, 3.8% financial abuse, 2.7% physical abuse, and 0.7% sexual abuse. A recent systematic review and meta-analysis of 13 cross-sectional studies of elder abuse and neglect estimated that the prevalence of abuse ranged from 4.5 to 61.7% across rural areas (Zhang et al., 2022). The authors estimated the prevalence of psychological/emotional abuse at 17%, neglect at 26%, physical abuse at 7%, and financial abuse at 5%. The structure and culture of rural environments may contribute to and conceal the prevalence of elder abuse. Research suggests that close social ties with community providers, patriarchal views of family, and low levels of education and economic security may exacerbate abuse and violence experienced by older women living in rural areas (Dimah & Dimah, 2003; Riddell et al., 2009; Teaster et al., 2006). Estimating the prevalence of elder abuse also is hampered by methodological limitations including the lack of consensus on the definition of elder abuse, differences in the design of existing data sources, scarcity of population-based studies, and range of study informants, which results in difficulties in comparing data (Rigon et al., 2022). For example, Ho et al.’s (2017) meta-analysis of the global prevalence of elder abuse found that third parties or caregivers tend to report a higher prevalence of elder abuse than older adults who experience abuse. Older adults living in non-western countries also  were more likely to report abuse than those living in western countries. Financial abuse was more prevalent in population-based studies than in studies in which a third party or caregiver responded about the occurrence of elder abuse. Although cited infrequently in the elder abuse literature, three national data sources are available that includes prevalence and demographic information about older adults who experience family violence (Addington & Lauritsen, 2021). The National Incident-Based Reporting System (NIBRS) collects data on crimes against persons and crimes against property, including victim age and family relationship details. For example, in 2020, 123,294 crimes against persons aged 61 and older occurred nationwide (Federal Bureau of Investigation, n.d.). The National Intimate Partner and Sexual Violence Survey (NISVS) provides national- and state-level estimates of violence against women and men. In 2010, the survey first included specific questions for adults over the age of 70 regarding psychological and physical abuse. Based upon a sample of 2185 older adults (1405 women), aged 70 and older, 12.0% of older adults experienced psychological abuse and 1.7% experienced physical abuse in the year prior to completing the survey (Rosay & Mulford, 2017). The FBI Uniform Crime Reporting (UCR) program has morphed into a national incident-­based collection of the most serious offense per incidence of a crime known to the police that captures demographic information on victims and offenders, victim–offender relationship, incident location, weapons, injury, time of day, and arrest. Although previously collected data are still available, the UCR program transitioned to an NIBRS-only data collection in 2021.

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2 Risk Factors Associated with Elder Abuse Risk factors associated with elder abuse include both personal characteristics and vulnerabilities of older persons who experience the abuse and family members who perpetrate the abuse. Community-dwelling older adults with three or four risk factors had a 3.9-fold greater risk of confirmed abuse than a comparison group of older adults who had not experienced abuse, and the risk increased to 26.7 times as great in older adults with five or more characteristics (Dong & Simons, 2014). Except for the few national studies of elder abuse, studies that identified risk factors for elder abuse tend to be predicated on cross-sectional studies with small samples and fail to examine how individual characteristics and life circumstances may converge to heighten the likelihood of the occurrence of abuse (Pillemer et  al., 2016). While victims and perpetrators often share similar characteristics and vulnerabilities, how each plays out and contributes to the abusive situation differs across family situations. Thus, empirical evidence for risk factors for elder abuse is mixed (Johannesen & LoGiudice, 2013; Roberto, 2016, Storey, 2020), with only one study suggesting that perpetrator traits may be a stronger predictor of elder abuse than victim characteristics (DeLiema et al., 2018).

Age, Gender, Race, Ethnicity, and Sexual Identity Family perpetrators of elder abuse range in age from teenagers (e.g., grandchildren) to older adults (e.g., spouse/partner). The National Elder Mistreatment Study (NEAM; Acierno et al., 2009) found that older adults aged 60–69 were more susceptible to abuse whereas smaller investigations that tend to focus on specific types of abuse (i.e., financial) identified adults aged 75 and older as being particularly susceptible to abuse (Metlife Mature Market Institute, 2009). The association between higher age and risk of abuse may be linked to a decline in functional health, which often results in a greater dependence on family members for assistance with daily tasks. Similarly, greater longevity resulting in associated agerelated changes and dependencies may contribute to older women being perceived at greater risk for abuse than older men. This is not to say that elder abuse is not prevalent in the lives of older men. Rather, Kosberg (2014) argued that the lower numbers of older men in many elder abuse studies is in part due to the failure of men to acknowledge and report abuse. Except for studies of IPV in late life, which consistently find that men are more likely to be the perpetrators of violence than women (Roberto et  al., 2013b), researchers tend to report lack of gender differences among perpetrators of elder abuse (Conrad & Conrad, 2019). Racial or ethnic minority status is a frequently identified risk factor for elder abuse, although empirical research is lacking. While analysis of the NEMS did not reveal significant race- and ethnicity-based differences in the prevalence of abuse (Hernandez-Tejada et al., 2013), researchers reported differences among race/ethic

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groups smaller studies. For example, compared to older adults who are White, Latinx, or Asian, African American older adults were three times more likely to report financial abuse and four times more likely to report psychological abuse than non-African Americans (Beach et  al., 2010). Some research suggests that Latinx older adults were less likely than other race/ethnic groups to report both verbal and financial abuse (Morrissey et al., 2022). Among Native American older adults, family stressors including substance abuse, poverty, and intra-familial conflict are frequently cited as causes of elder abuse (Jervis et al. 2017). Culture affects how racial and ethnic groups perceive elder abuse (Li et  al., 2020). For example, for Chinese American families, shared values of filial piety (i.e., expectation that adult children care for their aging parents) across generations were a protective factor for elder abuse whereas cultural disparities around filial obligations can be major sources of family conflict and increase the risk of elder abuse. Similarly, the high importance of familism (i.e., propensity to place the needs of the family unit ahead of those of individual family members) among Latinx older adults can place them at increased vulnerability for abuse (Morrissey et al., 2022). Respect is key to American Native older adults’ conceptualization of good treatment of older persons. Lack of care by family members, including placing older relatives in nursing homes, is considered neglect (Jervis et al., 2017). Lesbian, Gay, Bisexual, and Transgender (LGBT) older adults face the same possibility of abuse and violence perpetrated by family members as older adults in general. Among 2560 LGBT adults aged 50 to 95, approximately 7% reported that they had experienced verbal abuse by a partner, family member, or close friend, and 3% had experienced physical abuse (Fredriksen-Goldsen, et al., 2011). Studies specific to abuse experienced by LGBT older adults by a family member are nonexistent. Anecdotal stories of  the experiences of younger LGBT survivors of IPV suggest specific ways in which being LGBT can be used by perpetrators of abuse as power and control tools that include threatening to “out” the older person and instilling fear of “spending the rest your life alone,” and harping on “authorities’ prejudices” that they will not be believed (Cook-Daniels, 2017, p. 544). Thus, they may be reluctant to seek help because of the personal, familial, and societal risks in coming out as LGBT (Teaster & Sokan, 2016).

Physical and Cognitive Health Many studies have found an association between physical health problems, functional impartment, and chronic health conditions and various types of elder abuse victimization (Storey, 2020). For example, the likelihood of financial exploitation by family members has been found to be higher among older adults with more severe physical disabilities, whereas poor overall health is predictive of perceived neglect by caregivers (Acierno et al., 2009).

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Both typical and non-typical changes in cognitive functioning (e.g., memory, decision-making, information processing speed) place older adults at increased risk for all forms of elder abuse (Dong et al., 2011). Cognitive impairment is one of the most consistently identified risk factors that make older adults vulnerable to elder abuse. Tronetti (2014) reported overall lifetime prevalence rates for elder abuse of persons living with dementia that ranged from 27.5% to 55%. As memory declines and associated behavioral and communication problems increase or become more intense, the stress, strain, and burden of providing care for a family member often escalates (Ornstein & Gaugler, 2012; Roberto et al., 2013a). The prevalence of psychological aggression by well-intended caregivers of persons living with dementia ranged from 30% to 60% and infliction of physical abuse ranged from 5.4% to 23.1% of cases (Wiglesworth et  al., 2010). Family caregivers using physical and other abuse had lower emotional health, more role limitations, and poorer emotional status than caregivers who were not perpetrators of elder abuse. Abusive behaviors by persons living with dementia toward their family caregivers (e.g., shouting, hitting) also appear to provoke abuse behaviors of caregivers (Cooper et al., 2010).

Mental Health and Substance Abuse Family perpetrators of elder abuse frequently have a history of mental health conditions (Jackson & Hafemeister, 2011), most commonly depression (Yon et al., 2017). Family caregivers who experience depressive symptoms are more likely to exhibit potentially harmful behavior which can escalate to various types of abuse (MacNeil et al., 2010). A study of family caregivers of persons living with dementia found high levels of depression increased the risk of verbal abuse of their relative (Kohn & Verhoek-Oftedahl, 2011). Feelings of resentment toward a relative needing care add to caregiver anger and increase the potential for harm (Johnson et  al., 2022). Other behaviors associated with perpetrators’ mental health conditions that may place older relatives at risk for abuse include distortion of reality, inability to empathize, lack of impulse control, and inability to handle frustration (Anetzberger, 2013). Older adults who abuse substances are at greater risk of becoming the victims of elder abuse than those who do not abuse substances (Conrad et al., 2019). They may misuse alcohol and other substances to cope with depression, loneliness, and loss of purpose, making them less aware that they are receiving inadequate or harmful care (Teaster & Brossoie, 2016). Substance abuse also is commonly reported among family perpetrators of elder abuse. Perpetrators who used alcohol or other drugs were more likely to be men than women and can signal desperate attempts on the part of a family member to cover over feelings of inadequacy and an unhealthy dependency on the older adult (Conrad et al., 2019). Analysis of the NSEM found that perpetrators of emotional, physical, and sexual abuse had a much higher incidence of substance abuse problems (21–56%) than the general population (11%) (Amstadter et al., 2011).

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Social Isolation and Social Support Numerous studies have identified an association between social isolation and lack of social support and an increased risk for elder abuse (Roberto, 2016; Storey, 2020). When older adults are socially isolated, abuse is more likely to go undetected. Older adults who perceived deficits in social support were more than three-­ times as likely to report the occurrence of elder abuse than those who had an engaged support network (Acierno et al., 2009). Similarly, perpetrators who perceive themselves as socially isolated, lonely, and lacking social support are at higher risk for committing elder abuse (Storey, 2020). Strong physical or emotional connection between older adults and their family members may be a protective factor against abuse or place older adults in a vulnerable situation. For example, shared living space with a family member provides support and assistance for older persons and thus, decrease their risk of abuse by other family members. Conversely, shared living arrangements present increased opportunities for isolating older adults, which increase their vulnerability for abuse by occupants of the household (Fraga Dominguez et al., 2021).

Ageism Ageism is a more recently recognized risk factor for abuse and violence toward older persons (Phelan & Ayalon, 2020; Pillemer et al., 2021). At the individual level, negative age stereotypes and implicit and explicit dehumanization thoughts of family members (i.e., perceptions of older adults as animals vs. human) predicted a tendency toward elder abuse (Chang et al., 2022). Specifically, half of the 575 family caregivers in the study implicitly dehumanized older adults and almost one-third explicitly dehumanized them. Family caregivers who reported higher implicit dehumanization of older persons had a greater likelihood of reporting proclivity to elder abuse. On a societal level ageism appears in public discourse, media depictions, and everyday culture (NCEA, n.d. -c). In addition, age prejudice is embedded in institutional practices, policies, and procedures that reinforce and perpetuate bias and discriminate against older adults. Chang et  al.’ (2021) cross-national study of 56 countries found that discriminatory social policies and prejudicial social norms against older persons were associated with greater prevalence of violence toward older persons aged 70 and older.

3 Elder Abuse and Violence Perpetrated by Family Members The relationship between abusive family members and their older relatives is complex. Family relationships often involve issues of control, dependence, and interdependence. Synergistic dependencies are “situations wherein both members

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of the family dyad manifest excessive dependency of one form or another” (Bornstein, 2019. p. 713). These synergistic dependencies also contribute to abuse and violence within late life families.

Spouse/Partner Abuse by a spouse/partner may manifest as a continuation of longstanding abuse within a single relationship, as engagement in a series of violent intimate relationships over the life course, as violence within a continuing relationship that starts in old age, or as violence that begins with a new relationship in the later years (Crockett & Brandl, 2020). Interviews with women aged 54 to 70 who had left their abusive partner later in life revealed that 9 of the 10 women had been in multiple abusive marriages/partnerships with men (Roberto & McCann, 2021). Although they experienced infrequent, if any, physical abuse in later life, almost all the women dealt with psychological/emotional abuse, which is a common change in the way abuse and violence manifests itself in late life spouse/partner relationships (Acierno et al., 2009). Some older women did not recognize long-standing behaviors in their relationship, such as controlling behaviors and isolation, as psychological abuse and therefore were hesitant or unlikely to seek help and support to end the relationship (Roberto & McCann, 2021; Teaster et al., 2006). Like other types of abuse, sexual abuse can be present in a couple’s relationship from the outset or start shortly after the beginning of the relationship and may co-­ occur with a range of other abusive and violent behaviors (Bows, 2018). A common theme found among 19 older women, aged 62 to 83, who experienced lifelong sexual violence by their spouses was that they “thought things would be different now that we are older” (Band-Winterstein & Avieli, 2022; p. 456). Three major patterns emerged in their relationships over time. The women experienced an escalation of sexual violence when the children left the family home as aging changed the alignment of power and control in the couples’ relationship. Some women described a transformation of the violence they experienced from hands on physical sexual abuse to hands off emotional and verbal sexual abuse. Others described a pattern of sexual separation where limitations imposed by their husband’s illnesses provided the women relief from physical sexual abuse, but they still coped with painful memories of years of physical and sexual violence.

Adult Children Traumatic events and threat of being denied emotional or instrumental support can lead to acts of abuse within adult child–parent relationships. Adults who have experienced childhood abuse often continue to experience challenges in the relationship with the perpetrating parent. They may have ambivalent feelings about helping or

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caring for their parents in late life (Kong & Martire, 2019), which could lead to neglect and abandonment of a parent in need of care. A recent longitudinal analysis that tracked patterns of abuse over time and relationships indicated that child abuse was a risk factor for the perpetration of elder abuse by an adult child (Herrenkohl et  al., 2021). The authors contend that ambivalent and sometimes hostile feeling about the parent–child relationship may lead to abusive encounters in late life. Adult children who are abusive are often dependent on their parents for shelter, finances, and emotional support (Jackson & Hafemeister, 2012). They may become abusive when a parent refuses to provide money or other types of support the child demands. Conversely, when older adults are dependent on a family member for their care, the potential for abuse also may escalate. Although most family caregivers do not hurt or harm their older relatives, for some, the amount or level of care required becomes overwhelming and well-intended caregivers respond by lashing out verbally or physically and the quality of care may decline (Ramsey-Klawsnik, 2000). In situations of mutual dependency, economic dependency of adult children on their functionally dependent older parents for whom they provide care significantly increased the risk of elder abuse (DeLiema et al., 2018). In abusive families, reliance on parents has been associated with the adult child’s drug addiction (Jackson & Hafemeister, 2014). The national opioid crisis has shed renewed attention of how older adults are negatively affected by family members who struggle with addiction. A study of 22 Adult Protective Service cases of elder abuse involving opioids found that older adults who were prescribed opioids were vulnerable to exploitation and neglect by their family caregivers, particularly when the perpetrators had a history of substance abuse (Roberto et al., 2022). The older adults were very protective of their adult children and typically claimed to suffer no ill effects (e.g., pain) from missing doses of their prescription (opioid) medication that their children had taken for their own use.

Grandchildren and Other Family Members Most elder abuse studies, regardless of sample size or study design, include a relatively small number of extended family members perpetrators (e.g., grandchildren, sibling, niece/nephew). The NEMS found that extended family members were responsible for 13% of emotional abuse, 12% of sexual abuse, 9% of physical abuse, and 7% of neglect of older family members (Acierno et al., 2009). A national study of elder financial abuse (Metlife Mature Market Institute, 2009) found that nephews and nieces (15%), grandchildren (13%) and other relatives (i.e., siblings, cousins; 13%) accounted for 41% of family perpetrators. While researchers tend to include information about extended family members in a description of their study samples (e.g., relationship to older victim), they often exclude them from primary analyses or combine them into a single group of “other” relatives. One of the few published studies specifically on grandchildren perpetrators focused on grandparents aged 60 and older who were raising their grandchildren

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(Brownell et al., 2003). Analysis of focus group data study revealed several instances of abusive behaviors by grandchildren such as punching, hitting, throwing objects, stealing money or prized possessions, destroying possessions, and threatening the grandparent with weapons. Based on the perceived frequency of and motive behind their grandchild’s behavior, grandparents distinguished between normative adolescent behavior, disrespectful behavior, and what they defined as threatening or harmful behavior. For example, they viewed stealing small amounts of money or non-valuable possessions as disrespectful behavior, whereas they categorized their grandchildren’s stealing of large amounts of money and valuables as abuse. In addition, they indicated that while physical abuse by their grandchildren was not uncommon, they concealed it from their child welfare workers and others for fear their grandchild would be taken from them and placed in foster care. Within qualitative studies of elder abuse, researchers may provide illustrative examples of abuse by family members other than spouse/partners or adult children, but these cases are not always evident without a full read of the publication. For example, the study of opioid-related elder abuse cited above included two examples of grandchildren abusing their grandmothers (Roberto et al., 2022). In the first case, a grandson with a record of substance abuse helped with his grandmother’s care. One of his tasks was picking up her medications from the pharmacy, which he kept for himself. Her physician was concerned she was not being properly cared for, but the grandmother denied that her grandson mistreated her. In the second case, a granddaughter caregiver co-resided with her grandmother. The grandmother’s doctor reported that the grandmother had a negative drug screening; he believed that she was suffering because of not receiving her pain or anxiety medication. The grandmother claimed someone had stolen her medications, but did not incriminate her granddaughter, who had a history of substance abuse.

4 Older Adult Perpetrators of Abuse and Violence Within Their Families While older adults are more often victims than perpetrators of abuse and violence, they too may inflict harm on others. With few exceptions, researchers have paid little attention to older adults who abuse a family member. In the case of IPV in late life (discussed above), research has shown that older males are at higher risk than females for perpetration, while females are at higher risk than males for victimization (Pillemer et al., 2016; Scott-Storey et al., 2023). In some cases, reciprocal abusive behaviors occur between victims and perpetrators in late life. For example, retaliating abuse was a newly acquired strategy used by older women who experienced IPV throughout their relationships (Roberto & McCann, 2021). The women often fended off or responded to abusive behaviors by becoming physically aggressive themselves or talking back and yelling at their spouse/partner. They also used controlling behaviors, such as threatening to take out a restraining order.

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Also receiving some attention is violence perpetrated toward relatives by older adults living with dementia. Along with the gradual decreases in cognition abilities and memory and increased anxiety and behavioral changes, dementia can lead to potentially violent outbursts. Approximately 20% of dementia family caregivers experience some form of violence or aggression over the course of their caregiving journey (Rosen et al., 2019). In some families, the abuse is a continuation of physical and verbal aggression by older parents toward their adult children that occurred prior to the caregiving relationship (Pickering et al., 2015). Abusive behaviors of persons living with dementia toward their family caregivers also appear to provoke abuse behaviors of caregivers (Cooper et al., 2010). Caregivers described shouting or occasionally hitting back in response to being abused.

5 Evidence-Based Interventions for Elder Abuse As noted by Burnes et  al. (2021), “The elder abuse field needs high-quality intervention research to assess the best strategies to combat the problem, but few such studies exist” (p.  1437). The authors raised concerns that interventions are being developed and deployed in the community without rigorous programmatic evaluation. In addition, some interventions may have negative consequences and even endanger older adults living in abusive families (e.g., breaching confidentiality; Baker et al., 2017). Program administrators need high quality data to support the value and effectiveness of the interventions they employ, to inform future program development, and to have evidence to help secure required resources for implementing intervention programs aimed at older adult victims as well as family perpetrators.

Promising Approaches Evidence of the efficacy, effectiveness, and efficiency of elder abuse interventions based on randomized controlled trials, empirically supported case treatments, rigorous program evaluations, and replication studies is lacking (Chambless & Hollon, 1998). Thus, the quality of elder abuse intervention research is weak and the strength of evidence for specific intervention models is low (Ayalon et al., 2016; Baker et al., 2017). Reviews of the intervention literature have identified promising strategies for elder abuse intervention at both individual and systemic levels (Ayalon et al., 2016; Pillemer et al., 2016). Based on descriptive evidence from multiple cross-sectional studies and community programs that report beneficial effects, interventions that show potential include education programs to promote awareness and detection of elder abuse, interventions for family caregivers, helplines, emergency shelters, and multidisciplinary teams.

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Education programs are a point of primary intervention for elder abuse. The purpose of these programs is to increase awareness of elder abuse by reaching out to different audiences including older adults (Brownell & Heiser, 2006), professionals (Ahmed et al., 2016; Sharp et al., 2018; Wangmo et al., 2017), and the general public (Busso et al., 2020; Stein, 2016). As these programs typically are designed as one-time sessions with little or no follow-up, it is unknown if such newly acquired knowledge leads to greater awareness and ultimately reduces incidences of abuse. Caregiver interventions may have a protective effect against elder abuse. These programs typically focus on developing coping skills. For example, the START (STrAtegies for RelaTives) program promotes the mental health of family caregivers of persons with dementia (Livingston et al., 2013). This psychoeducation program provided information about (a) dementia, caregiver stress, and where to get emotional support; (b) understanding behaviors of the family member being cared for, and behavioral management techniques; (c) changing unhelpful thoughts; (d) promoting acceptance; (e) assertive communication; (f) relaxation; (g) planning for the future; (h) increasing pleasant activities; and (i) maintaining skills developed. The study authors reported that caregivers in the intervention group reported less abusive behaviors toward the person living with dementia compared with caregivers in the treatment as usual group. As an early intervention to prevent abuse, national, state, and local hotlines (also referred to as helplines) provide an opportunity for individuals to anonymously seek advice and assistance regarding elder abuse. Most hotlines are typically staffed by trained volunteers or professionals trained to handle a broad array of issues, including elder abuse. Others are designed specifically for suspected elder abuse (e.g., Adult Protective Services hotline; Eldercare Locator; Pillemer et al., 2016). Hotlines provide information and referral services about counseling, housing, and legal help; however, information about follow-up by older persons seeking information is lacking. Emergency shelters and short-term supportive housing, a common community-­ based intervention, primarily focused on young and middle-aged women experiencing IPV, are underutilized by older women in similar situations. Compared to younger women, older women may need more private spaces, assistance with medications, group support with women of similar ages and life circumstances, and an accessible environment (James et al., 2015). Individual intervention programs specific for older adults experiencing abuse exist. Such interventions often use cognitive-behavioral therapy (Horrillo & Martinez, 2017) and focus on decreasing risk for elder abuse (Alon & Berg-Warman, 2014; Mariam et al., 2015), and increasing service-use of victims (Burnes, et al., 2016). In Canada, initiatives designed to provide individual in-person counseling and support, as well as educational and therapeutic support provided in a group setting, appear promising for older women experiencing violence (Weeks et al., 2015). Like other programs, information about the short- and long-term effectiveness of individual and group counseling programs is lacking.

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Finally, at a more systems level, numerous communities have created Multidisciplinary Teams (MDTs) that take a holistic approach to elder abuse intervention. Teams are comprised of professionals (e.g., physicians, social workers, law enforcement, Adult Protective Services workers) in the community who work with, or on behalf of, older victims. The primary function of MDTs is to offer expert consultation to service providers, identify service gaps and systems problems, advocate for change, provide training events, and coordinate investigations or care planning (Teaster et al., 2003). An evaluation of a multidisciplinary model in New York found that older adults who received intervention services from an integrated legal and social services team compared with outcomes of a social work-only intervention had a greater reduction in risk for elder abuse at case closure (Rizzo et al., 2015). Despite the growing number and promise of MDTs as a model of elder abuse intervention, as with other intervention practices, they require further evaluation.

6 Summary Abuse and violence within families threaten the health and well-being of a growing number of older adults. Individual, relational, cultural, and societal factors have been identified that place older adults at risk for elder abuse. The dynamics of the relationship between older adults and potential perpetrators also contribute to abuse and violence within late life families. However, the literature is inconsistent regarding the circumstances and extent these factors independently and collectively contribute to or deter the perpetration of abuse. National and state-level data as well as case-specific information gathered by MDTs, Adult Protective Services workers, and other community professionals and entities can provide valuable insights and sources of data as researchers look to disentangle influences on abuse of older adults by their family members. The quality of elder abuse intervention research is weak. Shortcomings of elder abuse intervention research include reliance on outcome measures that narrowly focus on the victim without consideration of other relational and situational influences (e.g., perpetrator characteristics, victim–perpetrator relationship, social systems) and the reliance on descriptive analyses of intervention process outcomes (Burnes et al., 2021). To begin to address these limitations, researchers must identify objective, well-validated outcomes that are important to victims of abuse as well as to the practitioners and programs who serve them. When developing and implementing interventions, researchers and service providers must work together to gather the comprehensive, evidence-based data needed to assess which intervention strategies and programs are most effective and efficient in preventing abuse and violence in late life.

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Johannesen, M., & LoGiudice, D. (2013). Elder abuse: A systematic review of risk factors in community-dwelling elders. Age and Ageing, 42(3), 292–298. https://doi.org/10.1093/ ageing/afs195 Johnson, M.  R., Lance, C.  E., & Williamson, G.  M. (2022). Care recipient controlling and manipulative behavior and caregiver depressive symptoms: The role of race, caregiver resentment, and mutual communal behavior. The Gerontologist, 62(2), 241–251. https://doi. org/10.1093/geront/gnab087 Kohn, R., & Verhoek-Oftedahl, W. (2011). Caregiving and elder abuse. Medicine and Health, Rhode Island, 94(2), 47–49. Kong, J., & Martire, L. M. (2019). Parental childhood maltreatment and the later-life relationship with parents. Psychology and Aging, 34(7), 900–911. https://doi.org/10.1037/pag0000388 Kosberg, J. I. (2014). Rosalie Wolf Memorial Lecture: Reconsidering assumptions regarding men as elder abuse perpetrators and as elder abuse victims. Journal of Elder Abuse & Neglect, 26(3), 207–222. https://doi.org/10.1080/08946566.2014.898442 Li, M., Chen, R., & Dong, X. (2020). Elder mistreatment: Across diverse cultures. Generations, 44(1), 20–25. https://www.jstor.org/stable/26992863 Livingston, G., Barber, J., Rapaport, P., Knapp, M., Griffin, M., King, D., et al. (2013). Clinical effectiveness of a manual based coping strategy programme (START, STrAtegies for RelaTives) in promoting the mental health of carers of family members with dementia: Pragmatic randomised controlled trial. British Medical Journal (Clinical Research Editon), 347, f6276. https://doi.org/10.1136/bmj.f6276 MacNeil, G., Kosberg, J. I., Durkin, D. W., Dooley, W. K., DeCoster, J., & Williamson, G. M. (2010). Caregiver mental health and potentially harmful caregiving behavior: The central role of caregiver anger. The Gerontologist, 50(1), 76–86. https://doi.org/10.1093/geront/gnp099 Mariam, L. M., McClure, R., Robinson, J. B., & Yang, J. A. (2015). Eliciting change in at-risk elders (ECARE): Evaluation of an elder abuse intervention program. Journal of Elder Abuse & Neglect, 27(1), 19–33. https://doi.org/10.1080/08946566.2013.867241 Metlife Mature Market Institute. (2009). Broken Trust: Elders, Family, and Finance: A Study on Elder Financial Abuse Prevention. https://drive.google.com/ file/d/1XtCM5_vEsGBwnHdzfvXCoE8Kh_rHVIcC/view Montero, I., Martin-Baena, D., Escribà-Agüir, V., Ruiz-Pérez, I., Vives-Cases, C., & Talavera, M. (2013). Intimate partner violence in older women in Spain: Prevalence, health consequences, and service utilization. Journal of Women & Aging, 25(4), 358–371. https://doi.org/10.108 0/08952841.2013.838854 Morrissey, M.  B. Q., Brownell, P., & Caprio, T. (2022). Intersectionality of race, ethnicity, and culture in neglect, abuse, and violence against older persons: Human rights, global health, and systems approaches in pandemics. In Handbook of interpersonal violence and abuse across the lifespan (pp.  4699–4719). Springer Nature Switzerland AG. https://doi. org/10.1007/978-­3-­319-­89999-­2_337 National Center on Elder Abuse. (n.d.-a). Research statistics and data: Definitions. https://ncea. acl.gov/What-­We-­Do/Research/Statistics-­and-­Data.aspx#definitions National Center on Elder Abuse. (n.d.-b). Research statistics and data: Types of elder abuse. https://ncea.acl.gov/What-­We-­Do/Research/Statistics-­and-­Data.aspx#definitions National Center on Elder Abuse (n.d.-c). Research statistics and data: Ageism and elder mistreatment. https://ncea.acl.gov/What-We-Do/Research/Statistics-and-Data.aspx#ageism National Research Council. (2003). Elder mistreatment: Abuse, neglect, and exploitation in an aging America. Panel to Review Risk and Prevalence of Elder Abuse and Neglect. The National Academies Press. http://www.ncbi.nlm.nih.gov/books/NBK98802/ Ornstein, K., & Gaugler, J.  E. (2012). The problem with “problem behaviors”: A systematic review of the association between individual patient behavioral and psychological symptoms and caregiver depression and burden within the dementia patient-caregiver dyad. International Psychogeriatrics, 24(10), 1536–1552. https://doi.org/10.1017/S1041610212000737 Pathak, N., Dhairyawan, R., & Tariq, S. (2019). The experience of intimate partner violence among older women: A narrative review. Maturitas, 121, 63–75. https://doi.org/10.1016/j. maturitas.2018.12.011

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Phelan, A., & Ayalon, L. (2020). The intersection of ageism and elder abuse. In A. Phelan (Ed.), Advances in elder abuse research: Practice, legislation and policy (pp.  11–22). Springer International. https://doi.org/10.1007/978-­3-­030-­25093-­5_2 Pickering, C.  E., Pieters, H.  C., Mentes, J.  C., Moon, A., & Phillips, L.  R. (2015). Gender, relationships, and elder abuse: Assessing aggression in mother–daughter dyads. Journal of Forensic Nursing, 11, 160–166. https://doi.org/10.1097/JFN.0000000000000073 Pillemer, K., Burnes, D., Riffin, C., & Lachs, M. S. (2016). Elder abuse: Global situation, risk factors, and prevention strategies. The Gerontologist, 56(suppl. 2), S194–S205. https://doi. org/10.1093/geront/gnw004 Pillemer, K., Burnes, D., & MacNeil, A. (2021). Investigating the connection between ageism and elder mistreatment. Nature Aging, 1(2), 159–164. https://doi.org/10.1038/s43587-­021-­00032-­8 Ramsey-Klawsnik, H. (2000). Elder-abuse offenders: A typology. Generations, 24(2), 17–22. https://www.jstor.org/stable/44878436 Ramsey-Klawsnik, H. & Heisler, C. (2014, May/June). Polyvictimization in later life. Victimization of the Elderly and Disabled, 17(1). Riddell, T., Ford-Gilboe, M., & Leipert, B. (2009). Strategies used by rural women to stop, avoid, or escape from intimate partner violence. Health Care for Women International, 30(1–2), 134–159. https://doi.org/10.1080/07399330802523774 Rigon, S., Dascal-Weichhendler, H., Rothschild-Meir, S., & Gomez Bravo, R. (2022). Elder abuse and neglect. In J. Demurtas & N. Veronese (Eds.), The role of family physicians in older people care (pp. 289–321). Springer. https://doi.org/10.1007/978-­3-­030-­78923-­7_18 Rizzo, V.  M., Burnes, D., & Chalfy, A. (2015). A systematic evaluation of a multidisciplinary social work–lawyer elder mistreatment intervention model. Journal of Elder Abuse & Neglect, 27(1), 1–18. https://doi.org/10.1080/08946566.2013.792104 Roberto, K. A. (2016). The complexities of elder abuse. American Psychologist, 71(4), 302–311. https://doi.org/10.1037/a0040259 Roberto, K.  A. (2017). Perpetrators of late life polyvictimization. Journal of Elder Abuse & Neglect, 29(5), 313–326. https://doi.org/10.1080/08946566.2017.1374223 Roberto, K.  A., & Hoyt, E. (2021). Abuse of older women in the United States: A review of empirical research, 2017-2019. Aggression and Violent Behavior, 57, 101487. https://doi. org/10.1016/j.avb.2020.101487 Roberto, K. A., & McCann, B. R. (2021). Violence and abuse in rural older women’s lives: A life course perspective. Journal of Interpersonal Violence, 36(3–4), NP2205–2227NP. https://doi. org/10.1177/0886260518755490 Roberto, K.  A., McCann, B.  R., & Blieszner, R. (2013a). Trajectories of care: Spouses coping with changes related to mild cognitive impairment. Dementia, 12(1), 45–62. https://doi. org/10.1177/1471301211421233 Roberto, K. A., McPherson, M., & Brossoie, N. (2013b). Intimate partner violence in late life: A review of the empirical literature. Violence Against Women, 19(12), 1538–1558. https://doi. org/10.1177/1077801213517564 Roberto, K.  A., McCann, B.  R., Teaster, P.  B., & Hoyt, E. (2022). Elder abuse and the opioid epidemic: Evidence from APS cases in central Appalachia. Journal of Rural Mental Health, 46(1), 50–62. https://doi.org/10.1037/rmh0000181 Rosay, A. B., & Mulford, C. F. (2017). Prevalence estimates and correlates of elder abuse in the United States: The national intimate partner and sexual violence survey. Journal of Elder Abuse & Neglect, 29(1), 1–14. https://doi.org/10.1080/08946566.2016.1249817 Rosen, T., Makaroun, L.  K., Conwell, Y., & Betz, M. (2019). Violence in older adults: Scope, impact, challenges, and strategies for prevention. Health Affairs, 38(10), 1630–1637. https:// doi.org/10.1377/hlthaff.2019.00577 Scott-Storey, K., O’Donnell, S., Ford-Gilboe, M., Varcoe, C., Wathen, N., Malcolm, J., & Vincent, C. (2023). What about the men? A critical review of men’s experiences of intimate partner violence. Trauma, Violence, & Abuse, 24(2), 858–872. https://doi.org/10.1177/ 15248380211043827

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Sharp, C. A., Moore, J. S. S., & McLaws, M. L. (2018). The coroner’s role in the prevention of elder abuse: a study of Australian Coroner’s Court cases involving pressure ulcers in elders. Journal of Law and Medicine, 26(2), 494–509. PMID: 30574733. Soares, J., Barros, H., Torres-Gonzales, F., Ioannidi-Kapolou, E., Lamura, G., Lindert, J., de Dios Luna, J., Macassa, G., Melchiorre, M. G., & Stankunas, M. (2010). Abuse and health among elderly in Europe. European Commission, Executive Agency for Health and Consumers. https://www.diva-­portal.org/smash/get/diva2:377016/FULLTEXT01.pdf Sormanti, M., & Shibusawa, T. (2008). Intimate partner violence among midlife and older women: A descriptive analysis of women seeking medical services. Health & Social Work, 33(1), 33–41. https://doi.org/10.1093/hsw/33.1.33 Stein, K. (2016). Rosalie Wolf Memorial Lecture: A logic model to measure the impacts of World Elder Abuse Awareness Day. Journal of Elder Abuse & Neglect, 28(3), 127–133. https://doi. org/10.1080/08946566.2016 Stöckl, H., & Penhale, B. (2015). Intimate partner violence and its association with physical and mental health symptoms among older women in Germany. Journal of Interpersonal Violence, 30(17), 3089–3111. https://doi.org/10.1177/0886260514554427 Storey, J. E. (2020). Risk factors for elder abuse and neglect: A review of the literature. Aggression and Violent Behavior, 50, 101339. https://doi.org/10.1016/j.avb.2019.101339 Teaster, P.  B., & Brossoie, N. (2016). The intersection of elder abuse and alcohol misuse. In A. Kuerbis, A. A. Moore, P. Sacco, & F. Zanjani (Eds.), Alcohol and aging: Clinical and public health perspectives (pp. 131–147). Springer. Teaster, P. B., & Roberto, K. A. (2020). Perpetrators of elder abuse. In R. Geffner, J. W. White, L.  K. Hamberger, A.  Rosenbaum, V.  Vaughan-Eden, & V.  I. Vieth (Eds.), Handbook of interpersonal violence and abuse across the lifespan. Springer Nature Switzerland AG. https:// doi.org/10.1007/978-­3-­319-­62122-­7_91-­1 Teaster, P.  B., & Sokan, A.  E. (2016). Mistreatment and victimization of LGBT elders. In D. A. Harley & P. B. Teaster (Eds.), Handbook of LGBT elders: An interdisciplinary approach to principles, practices, and policies (pp. 43–64). Springer Science. Teaster, P.  B., Nerenberg, L., & Stansbury, K.  L. (2003). A national look at elder abuse multidisciplinary teams. Journal of Elder Abuse & Neglect, 15(3–4), 91–107. https://doi. org/10.1300/J084v15n03_06 Teaster, P.  B., Roberto, K.  A., & Dugar, T.  A. (2006). Intimate partner violence of rural aging women. Family Relations, 55(5), 636–648. https://doi.org/10.1111/j.1741-­3729.2006.00432.x Tronetti, P. (2014). Evaluating abuse in the patient with dementia. Clinics in Geriatric Medicine, 30(4), 825–838. https://doi.org/10.1016/j.cger.2014.08.010 Wangmo, T., Nordström, K., & Kressig, R.  W. (2017). Preventing elder abuse and neglect in geriatric institutions: Solutions from nursing care providers. Geriatric Nursing, 38(5), 385–392. https://doi.org/10.1016/j.gerinurse Weeks, K., Dickinson, R., & Struthers, A. (2015). Older women fleeing violence and abuse in Canada: Bringing together separate spheres of practice. Journal of Elder Abuse & Neglect, 27(4–5), 454–469. https://doi.org/10.1177/1077801220988355 Weissberger, G. H., Goodman, M. C., Mosqueda, L., Schoen, J., Nguyen, A. L., Wilber, K. H., Gassoumis, Z. D., Nguyen, C. P., & Han, S. D. (2020). Elder abuse characteristics based on calls to the National Center on Elder Abuse Resource Line. Journal of Applied Gerontology, 39(10), 1078–1087. https://doi.org/10.1177/0733464819865685 Wiglesworth, A., Mosqueda, L., Mulnard, R., Liao, S., Gibbs, L., & Fitzgerald, W. (2010). Screening for abuse and neglect of people with dementia. Journal of the American Geriatrics Society, 58(3), 493–500. https://doi.org/10.1111/j.1532-­5415.2010.02737.x Williams, J. L., Racette, E. H., Hernandez-Tejada, M. A., & Acierno, R. (2020). Prevalence of elder polyvictimization in the United States: Data from the National Elder Mistreatment Study. Journal of Interpersonal Violence, 35(21–22), 4517–4532. https://doi.org/10.1177/0886260517715604 World Health Organization. (2011). European report on preventing elder mistreatment. https:// apps.who.int/iris/rest/bitstreams/1414003/retrieve

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Part II

Prevention and Intervention

Chapter 7

Theories of Family Violence: Implications for Prevention and Treatment Angela J. Hattery, Katherine Kafonek, Allison Monterrosa, Emma Freetly Porter, and Earl Smith

A Wisconsin man has been sentenced to prison more than a year after he called 911 to report that he had just murdered five family members. Christopher P. Stokes, 44, was sentenced to 205 years in prison for the April 2020 murders of Marcus Stokes, 19, Demetrius Thomas, 14, Tera Agee, 16, Lakeitha Stokes, 17, and Teresa Thomas, 41…. “Don’t know what in the world came over me. Woke up and just had blood on my mind. Something just wasn’t going right.”1 While extreme, the case above reflects the fact that family violence impacts millions of families living in the United States each year. In order to design the most effective prevention and intervention strategies, we must understand as much as we can about family violence. In this chapter we provide the reader with the theories that have been used to understand and explain family violence as well as an analysis of the strengths and weaknesses of each theory. After reading this chapter, the reader

 Harriet Sokmensuer, 2021, Wis. Man Who Killed 5 Family Members, Then Called 911 to Admit Murders, Gets 205  Years in Prison. https://people.com/crime/wisconsin-man-killed-5-familymembers-called-911-admit-murders-205-years-prison/ 1

Angela J. Hattery, Katherine Kafonek, Allison Monterrosa, Emma Freetly Porter and Earl Smith contributed equally with all other contributors. A. J. Hattery (*) · E. Smith University of Delaware, Newark, DE, USA K. Kafonek Stockton University, Galloway, NJ, USA A. Monterrosa California State University, San Marcos, San Marcos, CA, USA E. F. Porter Fordham University, New York, NY, USA © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 P. Sturmey (ed.), Violence in Families, Advances in Preventing and Treating Violence and Aggression, https://doi.org/10.1007/978-3-031-31549-7_7

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will be better positioned to consider the prevention and intervention strategies that are indicated by each of the frameworks and explicated in other chapters in this volume.

1 Definitions and Statistics Family violence is, by definition, violence that occurs in families. That being said, there is not widespread agreement about the definition of a family. We choose the broadest possible definition of “family” when we consider family violence. Families, we argue, are (a) those we choose to love, while they may or may not love us back; and/or (b) people with whom we share a biological connection; and/or (c) people with whom we share a legal connection (think marriage or adoption); and/or (d) people with whom we may or may not live; and/or (e) people whom we claim to love. Family violence occurs across the life course and includes child abuse, partner abuse (often referred to as domestic or intimate partner violence [IPV]), and elder abuse. Child abuse can be physical, emotional, or sexual and also includes neglect. According to the Administration for Children and Families Administration on Children, Youth and Families Children’s Bureau (“Child Maltreatment”, 2019) there were 656,000 victims of child abuse and neglect reported to Child Protective Services (CPS) in 2013. One-year-olds have the highest rate of victimization at 25.7 per 1000, and children aged 2 and 3 years have the second and third highest rates. By far the most common forms of child abuse is neglect; nearly 2000 children, or about 5 per day, died from abuse and neglect in 2013. The total lifetime cost of child maltreatment is $124 billion each year. Child sexual abuse is also, unfortunately, far too common. Children are most likely to experience sexual abuse by someone they know, including family members, coaches, troop leaders, and priests and pastors. Despite this fact, the majority of media attention focuses on children who are sexually abused by strangers who kidnap them and all too often hold them hostage, often for years. For example, on May 6, 2013 we learned of the 10-year ordeal of three young women who had been kidnapped by Ariel Castro. No one could believe that for 10 years on 2207 Seymour Avenue in Cleveland, Ohio Michelle Knight, Amanda Berry, and Gina DeJesus were being held captive (Glatt, 2015). Amanda Berry, the woman rescued by Charles Ramsey, had a six-year-old son. As incredible as this story of child neglect and sexual abuse is, it is not a rare phenomenon (Glatt, 2015). Partner abuse can also be physical, emotional, or sexual. In addition, it can include financial abuse as well as myriad forms of controlling behaviors and coercive violence. Applying a broad definition, violence can occur between current or previous partners, including people who are dating, living together, married, separated, or divorced. According to the Centers for Disease Control (Smith et al., 2017), approximately 1 in 5 women (nearly 20%) and approximately 1 in 7 men have experienced severe

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physical violence perpetrated by a partner, approximately 20% of women and 1 in 12 men have experienced sexual violence by a partner, and approximately 10% of women and 2% of men have been stalked by an intimate or ex-intimate partner. IPV violence can also take the form of teen dating violence (Smith et al., 2017). At its most extreme form, physical violence results in death; IPV accounts for approximately 9% of all homicides (Smith et al., 2017). In the United States, nearly 1500 women are killed each year by their intimate or ex-intimate partners; 63% of all women who are murdered were murdered by current or ex-intimate partners. In other words, two-thirds of women who are murdered each year (femicides) were murdered not by a stranger, not by someone in the streets, not by someone who invaded their homes or carjacked them or abducted them on a running path, they are murdered by someone who claims to love them (Hattery & Smith, 2021). Elder abuse can encompass a variety of behaviors and forms of violence. In some cases, elder abuse is a continuation of partner abuse. More often, however, elder abuse is perpetrated by other family members, including adult children, siblings, or non-familial caregivers. Elder abuse includes physical, emotional and sexual abuse, financial abuse and neglect. There is a widely held consensus that elder abuse is severely underreported and that as many as 2.5 million people over the age of sixty are the victims of abuse each year. “More than 1  in 10 adults who are 70 years of age or older (14.0%) have experienced some form of abuse in the past year, with 12.1% experiencing psychological abuse and 1.7% experiencing physical abuse. One in five victims (20.8%) were abused by both intimate and non intimate partners.” (Rosay & Mulford, 2017, p. 1) In January, The New York Times printed a piece about a 94-year-old woman named Minnie Motz, whose son, an Upper East Side doctor, had been accused of ripping his mother off to the tune of $800,000. The elderly woman’s daughter and a grand-niece suspected elder abuse and went to the district attorney. The chief of investigations in the D.A.’s office, which later indicted the doctor, said, “It’s a mini Astor case.” Mrs. Motz’s daughter said, “We’re upper-middle-class, intellectual people. I think people think this sort of thing doesn’t happen in families like that.… Of course, we do have the example of the Astors, don’t we?” They were both referring to the much-publicized case of the late Brooke Astor, the infinitely charitable New York icon, who is alleged to have suffered similar abuse at the hands of her son, former ambassador Anthony “Tony” Marshall, and his attorney, Francis X. Morrissey.2

The Astor case has cast a spotlight on an epidemic of elder abuse. Up to two million Americans, age 65 and older, have been victims of abuse or neglect by their caregivers, according to the National Center on Elder Abuse, and approximately 60% of those cases are by a family member. If this could happen to one of the richest women in the world, could it not happen to anyone?3

 John Richardson. “The Battle for Mrs. Astor.” Vanity Fair. SEPTEMBER 4, 2008 https://www.vanityfair.com/news/2008/10/astor200810 3  Deborah Roberts And Joan Martelli. “Brooke Astor Trial Verdict Latest in Long Family Drama.” ABC News. October 8, 2009. 2

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These statistics underscore the exceedingly common incidence of family violence across many different contexts and environments. The definitions help guide the theories of family violence that will be further explored in this chapter. Finally, it is important to understand that there are two approaches to theories of family violence: some theories, like family violence theory, are designed to explain family violence across the life course, whereas others, such as Johnson’s theory of situational couple violence are best able to explain fact patterns and predict only one form of family violence (Johnson & Leone, 2005).

2 Family Violence Theory Family Violence theory is arguably the most commonly used and frequently associated approach to understanding family violence. Family violence theory was developed by Richard Gelles and Murray Straus to explain all forms of family violence across the life course. Gelles and Straus developed family violence theory based on a set of “fact patterns” that were revealed using both qualitative and quantitative research methods. Though feminist scholars and activists, including Lenore Walker, Susan Brownmiller, Susan Griffin, Gloria Steinem, Diana E.  H. Russell, David Finkelhor, and Kersti Yllo had long understood that the majority of violence perpetrated in the United States took place “behind closed doors” and not, as the media and public perceived, by strangers in the streets, Gelles and Straus were among the first mainstream researchers to make this argument. For this reason, as well as for the fact that the instrument they developed to measure family violence has been used in hundreds of studies and been completed by tens of thousands of respondents, it is difficult to overestimate the impact that family violence theory has had on the field. In sum, Gelles and Straus (Straus et al., 2017; Straus, 1979) built a theory of family violence as a paradigm that centers conflict in families and violence or nonviolence as a response to it. Specifically, family violence theorists, like Gelles and Straus, argued that violence erupts in families when there is a conflict and the person with more power in the family engages in violence as a mechanism to control the other person and resolve the conflict. Parents use violence against their children, ranging from spanking to severe physical abuse, as a form of discipline designed to train children to behave appropriately (a conflict over behavioral expectations). Adult children navigate conflict with their aging parents by engaging in forms of violence. For example, adult children who are caring for parents with cognitive decline, dementia or even Alzheimer’s may feel entitled to payment for that care, and when it is not forthcoming (a conflict) they may engage in verbal abuse or financial abuse in order to resolve the conflict. https://abcnews.go.com/2020/Astor/brooke-astor-son-anthony-marshall-guilty-fraud-larceny/ story?id=8629431#:~:text=The%20Astor%20case%20has%20cast,are%20by%20a%20 family%20member.

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When it comes to partner violence, family violence theory interprets the “fact patterns” as indications that couples, too, may resolve conflict through violence, especially when non-violent strategies are ineffective or unavailable. Rooted in a framework of conflict, Gelles and Straus developed a tool, the Conflict Tactics Scale (CTS), that was designed to measure violence in intimate partner relationships. The CTS is by far the most widely used tool to gather quantitative data on family violence. It has appeared in more than 1000 peer-reviewed articles, and it has been deployed in a variety of different samples and thousands and thousands of people have completed the tool. The reach of the CTS, both empirically and theoretically, ensures that family violence theory is by far the most widely utilized framework by scholars and practitioners who focus on various forms of family violence. The CTS has also been utilized to gather data that inform revisions to family violence theory. In response to criticisms by feminist scholars that the CTS was not responsive to gender differences in experiences with family violence, the tool was revised (Conflict Tactics Scale – 2 [CTS2]). In order to be more inclusive of child–parent violence, the CTS was also revised and expanded (Conflict Tactics Scale Parents and Children) (Jones et al., 2002). The widespread use of the CTS as well as its revised tools, both the CTS2 and Conflict Tactics Scale Parents and Children has produced an extraordinary amount of empirical evidence to support the original family violence theory framework developed by Gelles and Straus. Yet, serious critiques remain, especially by feminist scholars. First, the CTS is framed around conflict. And, yet, as many feminist scholars and activists note, IPV in particular, but also child abuse and elder abuse frequently, take place when those involved do not identify an obvious conflict. As a result, respondents may not report violence that occurred outside of the context of a conflict, and this may result not only in under-reporting, but in gendered underreporting. Second, the CTS’ focus on conflict fails to account for violence that is part of a larger system of controlling behavior, some of which may not be physical, but is often just as damaging. We do note that the CTS2 attempted to address this critique by adding items that probed for sexual violence and emotional abuse. Finally, the CTS focused on counting events, not on the intensity or outcomes of violence. So, for example, if both members of a couple complete the CTS and both report a physical fight, but neither is asked to report the injuries that are sustained, the data will render invisible the fact, which is often the case, that the woman ended up in the hospital and the man had a few cuts and scratches.

Intimate Terrorism and Situational Couple Violence One of the outgrowths of the data produced by the CTS is a sub-theory of family violence theory, developed by Michael P.  Johnson and colleagues (Johnson & Leone, 2005), that focuses on distinguishing intimate terrorism from situational couple violence. According to Johnson and his colleagues, intimate terrorism is the kind of violence that feminists and activists are referring to when they talk about

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domestic violence or battering. Using data generated from the CTS, Johnson and colleagues argue that the significantly more common type of violence is what they term “situational couple violence” which is meant to distinguish severe violence from that which is both more common and less severe and occurs among couples who fight physically (Johnson & Leone, 2005). Feminist critiques of this distinction note that, just as is the case with all research that utilizes the CTS, incidents of physical violence that occur in the context of a conflict will be over-represented and lead to the over-estimation of the prevalence of situational couple violence and simultaneously significantly underestimate the occurrence of intimate terrorism, which, interestingly, is the form of IPV that most people agree is highly gendered with men perpetrating the vast amount of intimate terrorism against their women partners or ex-partners.

3 Feminist Theory Feminist theorists have long argued that IPV, and to a lesser degree other forms of family violence, including child abuse and elder abuse, are gendered (Hattery, 2009). Specifically, feminist theory posits that the gendered unequal distribution of power produces gender inequality in every conceivable institution from education to politics to the labor market; gender inequality is also evident in the home, and in far too many households, this gender inequality takes the form of violence. As Coster and Heimer (2021, p. 288) suggested: Because intimate relationships are by and large sites in which men and women perform and validate gendered identities and inequalities, the claim that patterns of violence are less gendered within intimate relationships than elsewhere seems questionable, at best. But feminist theories of gender do not simply suggest that men are more likely to be abusive and women are more likely to be victimized because of their gender, feminist theories of family violence focus on the ways in which people perform (or as West and Zimmerman (1987) refer to it, “do”) gender.

Specifically, our research, and that of others (DeMaris et  al., 2003; Franklin & Menaker, 2014; Golden et al., 2013), finds that role expectations, and in particular, men’s expectations of their women partners, are predictive of IPV. In our own work (Hattery, 2009; Hattery & Smith, 2020), we refer to this as rule and role enforcement. Similar to the framework provided by family violence theory, rule enforcement refers to the use of violence as a strategy for resolving conflict. For example, men may engage in emotional and physical violence as a form of discipline in an attempt to enforce rules for their women partner’s behavior. We interviewed men who told us that the trigger that ignited the violence they perpetrated against their wives and girlfriends was a conflict over expectations, for example, not having their dinner on the table at the specified time or for talking to other men in social settings, including at picnics, and in restaurants and bars. In contrast, role enforcement refers to the use

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of violence in order to enforce gender role expectations, especially hegemonic femininity. So, these same men told us that the conflict was both about the rule— what time dinner was supposed to be served—and the roles that wives and girlfriends are supposed to care for the men in their lives through traditional expressions of femininity, like cooking, keeping a clean house and caring for the children. Guadalupe-Diaz (2019) identifies the same phenomenon in their investigation of IPV in transgender relationships; violence is focused on the transgender member in the relationship, and often, especially for transwomen, is triggered by the abuser’s perception that his partner is failing to “pass.” Failing to pass is interpreted as another form of failing to achieve the feminine role. Just as in cisgender couples, IPV is a tool used to police gender and gender expression. Guadalupe-Diaz’s (2019) research confirms that feminist theory can be, and is, effectively utilized as a framework for explaining IPV in LGBTQ+ families. Grounded in gendered power and role expectations, violence in LGBTQ+ families is deployed not just to police gender, as Guadalupe-Diaz (2019) suggested, but also to underscore the ways in which violence, especially emotional and sexual abuse, can be used against a partner who is not “out.” Additionally, abusers in LGBTQ+ relationships exploit the fact that law enforcement and other institutions designed to assist in cases of domestic violence often do not recognize men as victims of IPV and women as perpetrators, and as a result, they often fail to respond or to act in cases involving LGBTQ+ couples. Failing to understand violence in LGBTQ+ families is a form of policing gender but in this case not the gender of the individual but the gender configuration of the couple. Though less often utilized by scholars of family violence to explain child abuse and elder abuse, feminist theory can be an effective framework for understanding both. Research on child abuse, for example, reveals that boys are more often the victims of physical child abuse whereas girls are more often targeted with sexual abuse. Physical abuse, often disguised as punishment, is, much like IPV, sometimes utilized as rule enforcement and other times it is a tool used to enforce role expectations. And, in both cases, boys more often pay the price. Boys are far more likely than girls to be disciplined for misbehaving. For example, it is commonly believed that boys need to be “broken” and physical violence is frequently the tool. Similarly, boys are policed for not behaving in stereotypically manly or masculine ways; boys are not supposed to cry, they are supposed to be tough, and when they are not, and a parent or caregiver believes they should be, they employ physical violence as a tool to reinforce the expectations of masculinity. We should note that boys’ masculinity is also policed through the violence of their peers (Pascoe, 2007). Child sexual abuse, though it often does involve young boys as victims, is epidemic among young girls. It can be perpetrated as part of violence in a teen dating relationship, along with other controlling behavior, but most often it is a tool of power and control deployed by older most often male siblings, fathers, stepfathers, mother’s boyfriends, and other adult male relatives. Like all forms of IPV, child sexual abuse is fundamentally about power and control, and thus feminist theory is a dominant framework in understanding it.

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Similarly, elder abuse can also be understood through the lens of feminist theory. Sometimes elder abuse is simply a continuation of IPV. More often, however, it is perpetrated by familial and paid caregivers. Women are most often the target, primarily because of the gendered nature of life expectancy; women of all races outlive men by 5–10 years, and thus they are at higher risk for being the targets of elder abuse. Because of the gendered nature of caregiving patterns, women, both family members and paid caregivers, are also most often the perpetrators of elder abuse. Of all the theories, feminist theory is the best positioned to explain the gendered nature of both perpetration and victimization of elder abuse.

4 Situational Theories As noted, Johnson and colleagues (Johnson & Leone, 2005) distinguished between situational couple violence and intimate terrorism. And, this framework is also useful for considering some forms of child and elder abuse. In many cases, both child and elder abuse, like situational couple violence, are not accompanied by a pattern of power and control but rather are a response to situational stress. Child neglect, the single most common form of child abuse, is, more often than not, a function of poverty; parents and caregivers simply do not have the financial capacity to provide adequately for their children. Providing parents with adequate resources to meet the needs of their child is the necessary intervention, not parenting classes or removing children from the home. In fact, Dorothy Roberts (2002) argues that the vast majority of Black children, 50%,  of whom  will have at least one “touch” by the child welfare system, are not victims of neglectful or abusive mothers, they are victims of poverty. Similarly, a high proportion of elder abuse, like child abuse, is a response to stress. Caregivers, often adult children, do not have the resources to care for their aging parents in ways that are healthy and non-abusive. As a result, elders, like children, face a high risk for neglect, but also for financial abuse. Adult children, often still struggling to raise their own children, a phenomenon termed the “sandwich generation,” may steal money from their aging parents in order to provide for their care and/or to help provide for other needs in their households. Finally, it is important to note, that when it comes to both child abuse and elder abuse, caregiving is extremely stressful, and in the United States it is conceived of as the responsibility of the individual. Caregivers, be they parents of young children or adult children caring for aging parents, may engage in physically and emotionally abusive behavior when they are in situations that put them at extreme stress. People who are responsible for raising teenagers while caring for aging parents, the sandwich generation, may lash out in abusive ways in response to the stresses of too much caregiving. Young parents, often without the toolkits to parent in non-abusive ways, are at higher risk for perpetrating child abuse. Thus, situational theories must be engaged alongside the major theories we summarize in this chapter when developing models to explain, prevent, and effectively intervene in all forms of family violence.

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5 Criminology Theories Broadly speaking, criminology is defined as the study of crime. Criminology theories can be useful in understanding family violence because they aim to explain the causes of crime. There are limitations to criminology theories when explaining a crime that is rooted in power and control, such as some forms of family violence, because criminology theories have historically been written by and for white cisgender, heterosexual men (Burgess-Proctor, 2006). In other words, feminist perspectives advocating for the study of women’s experiences were not prominent in the field of criminology until the late 1960s, emerging during the women’s movement. An important note relating to criminological theories is that, despite historical progress in bringing the female experience into analysis, the study of family violence and particularly gender-based violence remains largely focused on cisgender, heterosexual relationships with a male perpetrator and female victim. Criminology researchers within the last decade strive to advance theories in a more inclusive way. One important example of this is a study by Courtney Crittendon and colleagues (2020), which found that the conceptualization (definitions) and operationalization (measurement) of sex and gender in research studies of crime and victimization over the past five years remained a binary measure. Jessica Turchik et al. (2016) critically reviewed gender-specific criminology theories, including those discussed below, to demonstrate the urgent need for gender-inclusive language in our theorizing of sexual violence in order to develop a better understand male victims, female perpetrators, and same-sex violence. Another limitation to consider when applying criminology theories to understanding family violence is that most criminology theories explain offending, rather than victimization. Nonetheless, criminologists attempt to understand crime at an individual (micro-) and social structural (macro-) level. Criminology research strives to understand the prevalence of crime, the social context in which crime occurs, and, within a subdiscipline of criminology known as victimology, the experience of victimization (Daigle, 2022). Below, we identify and describe the following criminological theories that may be useful in understanding family violence: learning theories, general strain theory, and life course theory.

Learning Theories Learning theories are helpful in understanding how individuals learn to engage in crime. Most relevant to family violence, criminology research applies learning theories to the study of juvenile offending and, in some cases, the study of IPV. Specifically, learning theories can help explain how individuals learn about attitudes supportive of violence, and how violence is reinforced. Differential association can also explain how children who are exposed to domestic violence in the home learn to imitate the behavior in their own relationships (Sellers et al., 2005). A definition of the theories is more clearly explained below.

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Edwin Sutherland’s (1947) theory of differential association specified the process of learning crime by positing that criminal behavior is learned in interaction with intimate personal groups, such as friends or family. Integral to this theory is the idea that when criminal behavior is learned, an individual acquires definitions and values that are favorable and thus reinforce criminal behavior. Individuals’ differential associations, or interactions and learning of behaviors, with others can vary in frequency, duration, priority, and intensity (Sutherland, 1947). Robert Burgess and Ronald Akers’ (1966) differential reinforcement theory added psychological concepts—specifically, operant conditioning—to Sutherland’s theory to explain why someone would be encouraged to continue or discontinue crime as a result of receiving positive or negative reinforcements. Ronald Akers’ et al. (1979) social learning theory expanded on Sutherland’s research to explain how multiple crimes and deviant behaviors are learned. Social Learning Theory contends that both deviant and conforming behaviors are learned through four processes: imitation (observing), definitions (attitudes), differential reinforcement (costs and rewards of engaging in a behavior), and differential association (learning from interaction with others). Research finds that differential association and differential reinforcement are consistent predictors of IPV (Cochran et al., 2015; Sellers et al., 2005).

General Strain Theory Robert Agnew’s (1992, 2001) General Strain Theory (GST) explains how social factors motivate one to commit crime. According to this theory, there are three major sources of strain: (1) failing to achieve a goal, (2) harmful impulses, and (3) removal of positive impulses. Put simply, the presence of strain creates negative emotions (most commonly anger), and in the absence of coping, one engages in criminal behavior. More recent iterations of GST expand on which types of strain are most likely to lead to crime. Strain that is seen as unjust is more likely to lead to crime because it provokes anger and other negative emotions (Agnew, 2001). For example, in the context of IPV, the period when an individual attempts to terminate a relationship is the most dangerous because an abusive partner may react violently, refuse to accept the breakup, or retaliate against their partner. In an empirical test of GST, Lisa Broidy (2001) found that social context plays a significant role in the type of strain and the type of emotional response. Additionally, Broidy (2001) found sex differences: women are significantly more likely to respond to strain with non-angry affect and employ legitimate coping strategies than their male counterparts. GST differs from other criminology theories because it posits an indirect relationship between one’s strain, emotions, and crime, and supports interdisciplinary frameworks that explain family violence.

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Life Course Theory Finally, life course theory is a developmental perspective that explains how one’s involvement in crime changes over time. According to this perspective, significant life events, especially those in childhood and adolescence, impact one’s risk of engaging in criminal behavior. Risks in adolescence include developmental changes like puberty and social changes involving peer pressure (Laub & Lauritsen, 1993). The life course perspective emphasizes the role of social bonds in behavior, including the role of family support. Sampson and Laub’s (1990) age-graded theory examines the role of trajectories and transitions in adulthood that shape an individual’s criminal career. Turning points, such as marriage or employment, decrease the likelihood of engaging in crime because, with more social bonds, one has more social capital and would have more to lose by engaging in crime (Sampson & Laub, 1990). The age-graded theory of informal social control can also help explain the influence of exposure to family violence on victimization and perpetration risk later in life (Laub & Sampson 1993). For example, Dutton (2000) found that witnessing domestic violence disrupts child–parent emotional attachments, which affects children’s abilities throughout their lives in negative ways, especially in their adult intimate relationships. The life course perspective is a developmental framework that emphasizes (1) offending can change over time, and (2) that social bonds, including strong family relationships, increase one’s social capital and decrease the likelihood of committing crime.

6 Feminist Criminology As illustrated above, theories in criminology focus mainly on offending, and were developed to describe the experiences of boys and men. The analysis of the victimization and offending of girls and women in criminology is fairly new. There are three waves of feminism which developed within the women’s movement: the first wave (mid-late 1800s), the second wave (1960s and 1970s), and the third wave (1970s-present) (Burgess-Proctor, 2006). The second wave of feminism emerged during the Civil Rights Movement and the women’s movement in response to feminist scholars’ criticism that gender was not included in criminology research. The third wave of feminism, which is current and evolving, calls for even more inclusivity in criminology research. This most recent wave is led by women of color, lesbian feminists, third world or “Global South” feminists, and marginalized groups that call for expansion of the white, middle-upper class, cisgender, heterosexual narrative dominating feminist praxis (Burgess-Proctor, 2006). Feminist perspectives are interdisciplinary and offer valuable explanations for family violence that are gendered in nature, particularly IPV. As demonstrated by the efforts of third wave feminists, feminist criminology focuses on the ways in which multiple and shifting identities shape experiences of

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violence, including but not limited to sexual orientation, race, and geographic biography. Intersectionality describes the ways in which individuals’ identities—including, but not limited to, race, class, and gender—may interact to create overlapping experiences of disadvantage or privilege in relation to power structures (Crenshaw, 1989). The concept of intersectionality is informed by critical race theory, which examines how racism is embedded within the law (Delgado & Stefanic, 2005; Matsuda et al., 1993; West et al., 1995). Theorizing about anti-discrimination, which centered around Black women’s inability to bring forth discrimination lawsuits within the workplace based on both race and gender combined, allowed for the conceptualization of intersectionality as a framework for examining Black women’s unique dilemma within the judicial system. Intersectionality is a frame to view Black women’s experiences not as the sum of race and gender, but as multiplicative and interwoven (Crenhaw, 1989). Intersectionality also incorporates tenets of a Black feminist theoretical framework, which recognizes historical racializedgendered stigmas of Black women, their standpoint and social location in relations to systems of power (Combahee River Collective, 1983; Hull et al., 1982; Crenshaw, 1989; Hill Collins, 1990). Feminist theory, and specifically Black feminist criminology, are explained further in-depth below.

Black Feminist Criminology Potter’s Black feminist criminology (BFC) is a framework that recognizes the historical significance of racialized and gendered stigmas that shape Black women’s experiences at both the institutional (macro) and interpersonal (micro) levels (2006). Potter (2006, p. 109) asserted: BFC incorporates the tenets of interconnected identities, interconnected social forces, and distinct circumstances to better theorize, conduct research, and inform policy regarding criminal behavior and victimization among African Americans.

Potter (2006) introduced BFC as an analysis for Black women’s experiences with IPV and expands an analysis that goes beyond the effects of a central gender analysis of violent victimization of Black women, and tends to the intersections of Black women’s multiple marginalized identities. BFC incorporates a Black feminist lens (Hill Collins, 1990), an intersectional framework, and employs a critical race feminist theoretical analysis to examine Black women’s experiences and other racialized-­ ethnic groups that embody marginalized identities (Crenshaw, 1989; Potter, 2006, 2013). BFC’s expansive explanatory power includes the myriad ways that Black women experience violence, crime processing within the criminal-legal system, and pathways to criminal offending and victimization (Potter, 2006). It also serves as a sensitizing framework to examine the impacts of utilizing institutional resources for help-seeking for violent victimization of all types (interpersonal, community, and

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institutional) and captures the unique effects on Black women (Monterrosa, 2019). Traditional feminist criminological theories have historically treated race as a peripheral variable in relation to a central gender analysis (Daly, 1997; Hooks, 2000, Lewis, 1977; Potter, 2006), whereas BFC employs an intersectional frame, which posits that Black women’s experiences are influenced by their positionality and social location which result from being a part of, and embodying, both a stigmatized gender and racial group simultaneously, as well as examining the impacts of race, class, sexuality, etc. (Crenshaw, 1991; Potter, 2013). It is the confluence of these variables that makes Black women’s experiences both qualitatively and quantitatively different than that of their counterparts, on which traditional feminist criminological theories are largely based (Daly & Chesney-Lind, 1988; Daly, 1997). Research demonstrates that Black women face structural barriers which function to marginalize them and often produce negative lived and material outcomes within the criminal-legal sphere and the judicial system (Richie, 2000). Black women experience disproportionate rates of IPV (Richie, 1996; Potter, 2008). Black women who are navigating an abusive relationship are often criminalized and treated as the perpetrator of the violence, particularly when fighting for their survival. Extant research has documented that Black woman are disproportionately exposed to the criminal-legal system due to hyper-policing, criminalization of survival for intimate and sexual violence, racialized-gendered stereotypes, and that they experience differential treatment within the criminal-legal system (Collins, 2005; Cooper, 2018; Crenshaw, 1989; Ritchie, 2017; Richie, 2000). Queer and transgender Black women are particularly vulnerable for intimate and community violent victimization due to the intersections of racism, sexism, transphobia, homophobia and prevailing racial-gender stereotypes (Ritchie, 2017). Recent research reports that in 2020 there were 26 murders of trans and gender non-­ conforming people, and in the year 2020 there were 27, the majority of which were Black trans women (Forestiere, 2020). And, as Guadalupe-Diaz’s (2019) research suggests, queer and transgender Black women experience high levels of violence in their intimate relationships as well. Additionally, the child welfare system is an institution that functions to criminalize Black women, particularly when attempting to seek help for IPV. Black motherhood is disproportionately scrutinized and criminalized (Roberts, 1997). There exists an extreme disparity of poor Black mothers whose children have been forced into the foster care system and/or have had their reproductive rights violated (Roberts, 1997). Stressors associated with poverty and IPV may force some mothers to engage in crimes of survival which may subject them to the possible removal of children from their custody (Jaffe et al., 2014; Ritchie, 2017; Roberts, 1997). Finally, poor Black women experience discrimination when accessing public social services such as, Temporary Aid to Needy Families, public housing and Supplemental Nutrition Assistance Program benefits (Headworth, 2020). Women often utilize social service programs as a means to leave an abusive relationship (Hattery & Smith, 2007). Black women navigating abuse are especially subject to victimization and criminalization, particularly if the abuser attempts to control their partner by placing her in a situation where she may lose her benefits. For example,

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telling a social service agent that he was residing with her, which violates rules of public housing assistance, or that she sold her Supplemental Nutrition Assistance Program benefits for cash (Monterrosa and Hattery, 2022). Punitive models and carceral logics employed to police the boundaries of eligibility, participation, and/ or ability to benefit from these social services often lead to exposure to the criminallegal system (Richie, 1996, 2000) and incentivizes abusers to employ these punitive practices as a way to maintain power and control over their partner. The interconnectedness of these systems of power and oppression situate Black women as particularly vulnerable to violent structural and interpersonal victimization. The explanatory power of BFC allows researchers, activists, and practitioners to reconceptualize the impacts of Black women’s experiences with IPV by creating a lens which highlights Black women’s unique positionality in relation to broader systems of power and oppression and moves beyond an analysis of gender, but one that incorporates the compounded effects of embodying multiple marginalized identities, as Black women.

7 Psychological Theories In comparison to other schools of thought, psychological theories that aim to explain family violence tend to place more emphasis on individual, dyadic, and relational factors that influence violence, rather than on larger systemic factors. Despite this emphasis, psychological theories have more recently evolved to incorporate cultural, contextual, and systemic factors as key elements that impact family violence (Malley-Morrison & Hines, 2004, p. 16).

Cognitive Behavioral Theory Cognitive behavioral theory (CBT) is often considered to be an offshoot of Aaron Beck’s cognitive theory, which was formulated based on his work with depressed patients (Beck, 1964, 1967), and was also influenced by behaviorists of the time (Wedding & Corsini, 2019). The premise of the theory is that behaviors are learned, both in relationships through social learning and observation, and through reinforcement and punishment. Social learning theory, for example, which constitutes an influential behavioral theory that forms the basis of CBT, suggests that imitation is an important force that influences behavior (Bandura, 1969). This theory, therefore, lends itself to a conception of family violence that emphasizes the impact that being exposed to family violence has on subsequent perpetration of violence. That is, children may learn violence as a strategy for communication and conflict resolution, albeit a harmful and ineffective one. Reinforcement and punishment are other concepts derived from behaviorism that are considered capable of influencing

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behaviors, but they tend to be conceptualized as occurring through different mechanisms. Rather than children learning behaviors by imitating what they observe in their environment, in this case, caregivers take a more active role in providing children with feedback that influences their behaviors. For example, parents may criticize (i.e., a form of punishment) and belittle their children for crying, while they may offer praise (i.e., a form of positive reinforcement) for children being physically aggressive and expressing anger. In fact, there is evidence that assertiveness and aggression are more strongly reinforced in boys than girls (Marmion & Lundberg-Love, 2004). It is not just behavioral mechanisms that are relevant in CBT, but also cognitions and cognitive processes. CBT postulates that behaviors are often preceded by thoughts, thus making thoughts decidedly influential on actions. CBT argues that people often have automatic thoughts that flow constantly and naturally out of their core cognitive schemas; however, these automatic thoughts and cognitive schemas are subject to biases that, at times, render them illogical, overly generalized and inflexible. These cognitive biases and thinking errors are often referred to as cognitive distortions (Wedding & Corsini, 2019). In terms of family violence, this has several possible applications. As applied to perpetrators, this may suggest that early life experiences have informed the construction of cognitive schemas that are rigid and characterized by negative beliefs about themselves, others and the world. One example of this may be the relationship between rigid adherence to gender-role beliefs and interpersonal violence perpetration (Diaz-Aguado & Martinez, 2015; Lawson et al., 2010). Another example is the established link between perpetrators’ low self-esteem and violent behaviors (Diaz-Aguado & Martinez, 2015). These would suggest that perpetrators’ underlying beliefs and expectations for themselves and partners tend to influence violent behavior, which follows a CBT-informed explanation. A similar but inverted pattern may likely explain victims’ experiences through a CBT lens. That is, victims may be likely to have generalized and negative cognitive schemas about themselves, others and the world that then influence their behaviors in relationships. For example, if a victim’s core cognitive schema is that they are fundamentally unlovable, one can understand how this cognitive schema could be confirmed and upheld through mistreatment and violence. In summary, CBT and the behavioral and cognitive theories that comprise it would suggest that family violence is strongly influenced by what children observe and internalize from their social environments. Children learn through modeling and reinforcement what to expect in the world, which then in turn helps form their cognitive schemas. These schemas often become fixed, and individuals seek out relationships and experiences that confirm these pre-existing schemas. Therefore, when the environment is marked by criticism, unpredictability, and even abuse, neglect and violence, it stands to reason that these expectations become internalized.

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Attachment Theory Attachment theory, which is attributed to John Bowlby (1973, 1977, 1978), is deeply influential across the field of psychology in general, but it is also often invoked to explain family violence. Attachment theory is founded on the premise that the primary need of human beings is for social connection. Because of its primacy, infants learn early on whether they can rely on their caregivers to adequately attune to them and meet their needs with predictability, and this information forms their attachment style (J.  Bowlby, 1973; R.  Bowlby, 2007). This attachment style helps create an internal working model of relationships that becomes the template for future relationships (Wedding & Corsini, 2019, p. 35). Securely attached infants have come to expect that when they have a need, their caregiver reliably meets that need, which allows them to feel safe in the relationship, as well as safe to explore novel stimuli given that they know they have a secure attachment base (Bowlby, 2007). On the other hand, insecure attachment plays out in several different ways. Anxious attachment tends to occur when caregivers are inconsistent and mis-attuned, which can elicit fears of abandonment and a drive for closeness in an attempt to secure relationships. Avoidant attachment tends to occur when caregivers are unresponsive and unavailable, which leads to a reluctance for closeness and intimacy (Mikulincer et al., 2003). Attachment style has been linked to a variety of mental and physical health outcomes in adults. Insecure attachment styles have been linked with depression and anxiety (Muris et al., 2001), the development of PTSD symptoms following a traumatic event (Woodhouse et al., 2015), more severe psychosis (Carr et al., 2018) and personality disorder symptoms (Smith & South, 2020), and even adverse cardiac health outcomes (Heenan et  al., 2020). Furthermore, many studies have attempted to untangle the relationships between childhood maltreatment (including witnessing family violence), attachment style and subsequent relational outcomes. There is evidence to suggest an association between experiencing or witnessing abuse in childhood, insecure attachment styles, and the subsequent perpetration of interpersonal violence in adulthood (Tussey et al., 2021). Thus, the primary pathway that is put forth by attachment theory is the impact that one’s own attachment style has on their subsequent relational outcomes both positive and negative. For example, when children are raised in unpredictable environments wherein they cannot expect that their needs will reliably be met, they tend to form an insecure attachment style. In the case of avoidant attachment, they may come to withdraw from intimacy and instead attempt to meet their own needs rather than relying on others. In extreme forms, therefore, violence may be a vicious, but typically effective way to interrupt and ultimately destroy closeness with a partner. On the other hand, anxious attachment is preceded by unpredictability from caregivers, and it is driven by the fear of abandonment. This could also impact perpetrators’ violent behaviors in that they may lash out in situations of real or perceived abandonment. While this is not to say that all individuals with insecure (i. e., anxious or avoidant) attachment styles are violent or victims of violence, attachment theory helps provide an explanation of how family violence is perpetuated through

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the intergenerational transmission of strained, inconsistent, and in some cases, violent family relationships.

8 Family Systems Theory Family systems theory was developed by psychiatrist and researcher Dr. Murray Bowen (1913–1990) and is another psychological theory that is sometimes used to explain family violence. Though Bowen himself does not theorize about family violence, his perspective has been used and continues to be used into the twenty-­ first century by family therapists. Bowen conceptualized the family as a unit in a system that seeks homeostasis in order to ensure optimal functioning (Bowen, 1978). In looking closely at Bowen’s work, we can see the influence of sociologist Talcott Parsons whose work on systems theory was published in 1951. Specifically, the family systems approach focuses on family structure and in particular stability and traditional gender roles. When families are stable and gender roles are clear, there is significantly less conflict. It is this stress and conflict, then, that is viewed by those who apply Bowen’s theory in the family therapy setting, as the source of family violence, and IPV in particular. In therapeutic settings, Bowen’s theory is applied by focusing on reducing stress, restoring stability and establishing or re-establishing clear gender roles in families (Bowen, 1976). In addition, Bowen’s family systems theory conceptualizes the family as a part of a social system that is engulfed within interpersonal differentiation. This differentiation is important in that it allows us to distinguish our experience from the experience of people we are connected to including a spouse, children, in-laws, and so on. According to Bowen individuals in these relationships become inseparable— it is as if they live under the same “emotional skin”—and even among family members who feel disconnected, the behavior of individual family members can continue to significantly influence the feelings and behaviors of others. Bowen argues that the source of influence in most families is located in the husband/father, who is, in his perspective, meant to be the breadwinner and the head of the household (Bowen, 1978). One critique of Bowen’s theory is its applicability in a twenty-first-century America in which family structures and forms are increasingly variable and often less traditional. Can Bowen’s theory be utilized in an intersectional society where large-scale social change has interrupted so-called tradition in families? The landscape of families is that they are increasingly non-traditional, some families chose childlessness, partners may not legally marry, women are increasingly working outside of the home and contributing significantly to the family finances, and families are increasingly multi-racial, multi-gender, and part of the LGBTQ+ community.

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9 Conclusions In this chapter we have provided an overview of the prevailing theoretical frameworks that have been developed across several disciplines to explain family violence. Though scholars, advocates, and intervention specialists tend to work within silos, typically aligned with their training, we can see the benefit of bringing an interdisciplinary approach to the study and intervention of family violence, but also to prevention strategies. And, though intervention and prevention are not the focus of this chapter, we note that the most effective approaches to the prevention of family violence utilize the frame provided by the socio-ecological model. The socio-­ecological model, which includes societal, community and individual level strategies is ripe for the kinds of approaches that are suggested by each of the theoretical frameworks discussed in this chapter. For example, incorporating the framework of Black Feminist Criminology into therapeutic diagnosis and treatment of attachment disorder, recognizing that attachment may be shaped by structural as well as individual level forces, results in a more robust and effective intervention and prevention strategy designed to reduce family violence in Black families. Family violence is a complex social problem that requires the type of interdisciplinary approach we suggest here. We encourage readers to consider the myriad ways in which the theories we outline here can inform each other in ways that reduce the prevalence of all forms of family violence, including IPV, elder abuse and child abuse.

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Chapter 8

Individual Prevention and Intervention for Children Exposed to Intimate Partner Violence and Those Who Have Caused Harm Carla Smith Stover and Anahita Shafai

Intimate partner violence (IPV) constitutes threatened or actual physical, emotional, and sexual violence by one or both partners in an intimate relationship (CDC, 2015). One in four children are witness to parental IPV in their lifetime, and one in 15 youth are witness to parental IPV annually in the United States (Hamby et  al., 2010). Parental IPV has significant deleterious impacts on youth exposed (Vu et al., 2016) and is regarded as a form of child maltreatment (Gilbert et  al., 2009). Experiencing parental IPV can have adverse psychosocial impacts for children who impede their development not dissimilarly to direct physical abuse (Sternberg et al., 2006). For example, between 17% and 33% of these children meet criteria for the diagnosis of posttraumatic stress disorder (PTSD) at school age (Graham-Bermann & Seng, 2005). Further, children experiencing IPV in the home are 5 times more likely to be sexually abused and 2.5 times more likely to be physically abused than those living in homes without IPV (Zolotor et al., 2007). The overlap of IPV and child maltreatment is in the range of 40–60% (Hamby et al., 2010), and those experiencing both IPV and child maltreatment are at even greater risk for poor psychosocial outcomes including greater mental health, academic and social difficulties (Osofsky, 2003). The need for prevention and intervention strategies for families experiencing IPV is clear. This chapter will first introduce a brief overview of the effects of IPV on children’s functioning, and the potential mediators and moderators of these effects, followed by an exploration of the multiple avenues of intervention ranging from primary prevention to treatment models for children who have experienced

C. S. Stover (*) Yale University Child Study Center, New Haven, CT, USA e-mail: [email protected] A. Shafai Yale University Child Study Center and University College London, London, UK © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 P. Sturmey (ed.), Violence in Families, Advances in Preventing and Treating Violence and Aggression, https://doi.org/10.1007/978-3-031-31549-7_8

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IPV and interventions for parents who have caused harm. Finally, recommendations and areas for future development in the field will be outlined.

1 Impact of IPV on Child Development Several of meta-analyses show small to medium effect sizes for the association between IPV exposure and internalizing and externalizing symptoms, and a medium effect size for academic problems (Evans et al., 2008; Kitzmann et al., 2003; Wood & Sommers, 2011; Wolfe et al., 2003). Kitzmann et al. (2003) suggest that their average small to medium study effect size may indicate that around 63% of IPV-­ exposed children had poorer outcomes than the average child not exposed to IPV. These poorer outcomes can include developing enduring harmful cognitions about intimate and interpersonal relationships, ineffective emotion regulation abilities, and experiencing or using IPV in adult relationships (McTavish et al., 2016). A meta-analysis investigating the intergenerational transmission of violence shows that for children facing exposure to IPV, there is a medium and small effect size for later using IPV and experiencing IPV, respectively (Stith et al., 2000). More recently, Vu et  al.’ (2016) meta-analysis focuses on the longitudinal prospective studies of adverse consequences of IPV exposure on children’s functioning to illuminate whether IPV is predictive of adverse child adjustment and whether the association between the two weakens or strengthens over time. The results of 74 studies indicate IPV exposure has cumulative effects over time. They suggest that IPV exposure in childhood is prospectively associated with externalizing, internalizing, and total maladjustment issues for children, and the scale of these associations grows over the lifespan of the child. They further report the effects of factors including child sex, race, and child maltreatment, and male and/or female perpetrated IPV, which may increase or decrease the risk of developmental maladjustment, still need further study. Moreover, the authors state assessments of children at a specific point in time that do not reveal adjustment problems should not be readily accepted as evidence for resilience but instead an indication that while children do not show adverse consequences at the current stage, they may show emergence of adverse consequences later in their development. There is also evidence to support that IPV has differential effects across developmental stages. A review by Carlson et al. (2019) details that IPV exposure in the infant and toddler period results in higher levels of trauma symptoms, externalizing behavior problems, and insecure attachments to their maternal caregiver. In the preschool period, children are more likely to have reduced executive functioning and memory skills, lower prosocial skills and social competence, and higher symptoms of anxiety, depression, and fearful reactions. For the school age and adolescence period, in addition to the cascading effects of insecure attachment and poorer self-­regulation mentioned above, children are also more at risk than their non-IPV-­exposed peers to be victims and perpetrators of both bullying and dating violence. Two important factors influencing the likelihood of developing such

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adverse outcomes are: (1) exposure to IPV at a younger age when the brain is still rapidly developing and insufficient emotion regulation abilities have been developed, and (2) the duration, chronicity, severity, and nature of violence that children witness. Developmental consequences tend to be more negative for children exposed earlier and with more cumulative trauma rather than those exposed to single events (Graham-Bermann & Perkins, 2010).

Mediators and Moderators of the Impact on Children Given that many children who witness IPV do not develop adverse outcomes, a number of other factors influence the extent to which children may be resilient or at risk (Graham-Bermann et al., 2009). First, a secure attachment relationship between children and at least one of their parental figures (which can include biological parents, grandparents, or anyone in a caregiving role) can act as a buffer against the stress and trauma that arise from childhood exposure to IPV (Zeanah & Gleason, 2010). Parental figures with secure attachment styles can provide positive, supportive, and sensitive care and involvement with their children, linked to a host of positive effects for children including better executive functioning and fewer behavioral and mental health problems. There is also reduced risk of the children experiencing IPV themselves in adolescence. It is theorized that a secure attachment to a primary caregiver can establish the child’s internal working model for healthy future relationships providing an alternative to the unhealthy interactions they may witness between their parents (Carlson et al., 2019; Mueller & Tronick, 2019). Two parental functioning factors that are closely related to a secure parent–child attachment relationship are the parent’s reflective functioning (RF) and emotion regulation (ER). RF is the ability to imagine mental states in oneself and others. Through this capacity for reflection, individuals develop the ability to understand their own feelings and behavioral responses and the responses of others as a meaningful attempt to communicate those inner mental states. Individuals with high levels of RF are better able to recognize their own and others’ thoughts, emotions, intentions, and desires (Fonagy et al., 1991). Parental RF refers to parents’ abilities to hold their children’s mental states in mind (Slade, 2005). Poor RF is associated with emotional dysregulation and increased violent and aggressive behavior (Fonagy, 2003; Taubner et al., 2013). Parents with low RF are more likely to display hostility, lower emotion regulation abilities, and negative interpersonal functioning (Fox & Benson, 2004; Stover & Coates, 2016). ER is the ability to monitor, evaluate, and modify one’s emotional reactions (Thompson, 1994). It is associated with RF, as those with poor RF also often have difficulty regulating their emotions. Parents with low emotion regulation abilities may display increased hostility, aggressive parenting, and dysregulated reactions to their children (Lee et al., 2020). Alternately, parents with high RF and ER skills can effectively mirror their child’s mental states (Fonagy et al., 1991) and help to externally downregulate distress before children have developed this skill, over time

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teaching the child to recognize and regulate mental states and calibrate their stress response independently (Mueller & Tronick, 2019). The development of such self-­ regulation is vital in serving a protective function against the stress, which can arise for children from being witness to IPV between parents. Supporting the above, a study demonstrated maternal reflective functioning mediated the association between IPV and children’s externalizing symptoms (Levendosky et al., 2006). Importantly, the IPV environment serves as a stressor for parents themselves, resulting in higher posttraumatic stress and lower protective parental functioning skills. Indeed, mothers’ own posttraumatic stress and depression symptoms have been found to influence higher trauma symptoms in their infants (Katz et al., 2016; Lannert et al., 2014). Overall, the caregiver’s mental health and stress is a significant influence on the development of children’s internalizing and externalizing symptoms beyond the witnessing of IPV alone (Carpenter & Stacks, 2009). The child’s wider environment can also act as a mediator. For example, children who are at an economic, educational, community, and neighborhood context disadvantage are not only more likely to be at greater risk of witnessing IPV but are also less likely to have supportive resources they can access, which buffer the stress effects arising from exposure than their more socially affluent counterparts with better support systems. Peer support can also positively influence outcomes, as children who have better quality communication with friends have fewer mental health symptoms and less likelihood of using IPV themselves (Carlson et al., 2019). Even youth’s perceived social support has been found to mediate the association between IPV exposure and outcomes (Owen et al., 2009). Therefore, it is important for intervention efforts to focus on socioecological targets and factors that may contribute to poor outcomes in the face of witnessing IPV.

2 Primary Prevention Primary prevention strategies can be a tool in limiting the impacts of IPV exposure on children, though findings on their effectiveness are mixed. These strategies may encompass media campaigns aiming to shift attitudes about IPV and generally raise awareness (Whitaker et  al., 2008); screening and intensive advocacy including home visits for women at risk for, or exposed to, IPV to prevent occurrence and recurrence (Rivas et al., 2015); and couples-based interventions to promote healthy marriages or relationships between young parents through focus on problem-­solving and positive communication (Whitaker et al., 2013). A more widely used strategy involves school implemented primary prevention programs for adolescent students. These are founded on evidence that dating violence in adolescence may be a precursor to later developmental consequences ranging from depression and anxiety to academic underachievement, and importantly, IPV in later adult relationships (Niolon et  al., 2019). Such educational programs target risk and protective factors for IPV such as beliefs around gender stereotypes, substance misuse, and anger management to promote healthy relationships for the

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10–25% of adolescents who experience physical and verbal dating violence (De La Rue et al., 2017). With the high prevalence rates of teen dating violence, attention, and resources are increasingly allocated to its prevention; yet, these violence rates have remained largely similar in the last two decades, and the efficacy of these programs on attitude and behavior change is unclear (Debnam & Temple, 2021). A meta-analysis by De La Rue et al. (2017) concluded that while these primary prevention programs positively influence students’ knowledge around dating violence, further research and modifications, such as targeting students earlier in their development and utilizing socioecological models, are required to influence behavior change and reduce violence itself. Overall, the success of primary prevention strategies is still under scrutiny, necessitating greater research on limiting children’s developmental impairment following IPV exposure (McTavish et al., 2016), and IPV interventions for those who have caused harm. The following section will detail advances in IPV interventions for those who have caused harm.

3 Interventions for Those Who Have Caused Harm Over the last decade, there has been an increase in the development of interventions for those who have caused harm. These have primarily focused on men who have used IPV behaviors but has also included some development of interventions focused on women who cause harm. Table 8.1 provides an overview of the interventions that have been studied with a focus on more recent works and those interventions with meta-analytic findings reported using those studies. A wide range of approaches have been developed for intervening based on different theories of the causes of IPV. These include power/feminist theory, where men’s use of control and gender roles against women are targeted; social learning theory, which focuses on individuals relearning nonaggressive conflict management and emotion processing; and trauma theory, which works to integrate an understanding of the body’s stress response to help individuals better cope with stress and trauma triggers and reduce poor coping that leads to violence. The most used approach nationally and internationally, particularly in court referred populations, is a group intervention focused on men’s use of power and control—specifically the Duluth model, which entails a gender-equality-based, psychoeducational group method attempting to change men’s attitudes around women and abusive behaviors (Pence & Paymar, 1993). The cognitive-behavioral treatment group (CBT) is also widely implemented and centers around changing cognition and emotion around IPV as a learned behavior. Many programs utilize a combination of the Duluth and CBT group models, often applied in a one-size-fits-all manner for men who are arrested following an incidence of IPV. Despite their wide usage, meta-analytic research shows that such programs have not been widely effective at reducing recidivism especially based on survivor reports in randomized controlled trials (Arias et al., 2013; Cheng et al., 2021; Babcock et al., 2004). Thus,

Meta-analysis Meta-analysis 2 experimental and 1 (Cheng et al., 2021) quasi-­experimental study

Meta-analysis 12 studies: 9 6 months to quasi-­experimental, 3 10 years across experimental studies

Meta-analysis (Arias et al., 2013)

Outcomes n = 5 experimental studies (d = 0.19); n = 7 quasi-­ experimental studies (d = 0.34)

1 year to BIPs in general effective at 1.5 years across reducing IPV and general offense studies recidivism by official reports but not by survivor reports. Significant effect size for quasi-experimental studies but nonsignificant for RCTs 6 months Participants in BIP + IMP reported significantly reduced violence postintervention

Lack of a significant treatment effect. Efficacy rate of 38% on recidivism. Weighted mean effect sizes between d = 0.12 and d = 0.41 for couple reports and official reports respectively on recidivism.

9-year 39% of completers and 37% of postprosecution noncompleters reoffended with a data violent act, 20% with more than one incident reported

Completers 156 male offenders: vs. 103 completed the noncompleters program and 53 dropped out

24-week Duluth model group (Herman et al., 2014)

Follow-up post-Tx 6–18 months across studies

Study design Sample N Meta-analysis 12 studies: 5 RCTs and 7 quasi-­ experimental studies

Research studies Meta-analysis (Babcock et al., 2004; Feder, 2005)

Standard BIP 35-session BIP with Randomized 160 men with 80 in with IMP vs. 35-session controlled trial BIP + IMP and 80 in Individualized BIP only BIP only Motivational Plan, Spain (Lila et al., 2018)

Model Duluth Model (Pence & Paymar, 1993)

Table 8.1  Outcomes for Interventions for Those who Cause Harm

23%

Data not provided

Data not provided

34%

Dropout rate 18–60% across studies

Spanish male batterers convicted of IPV participating voluntarily

Court-mandated male offenders

Court-mandated male offenders

Court-mandated male offenders

Population Court-mandated male offenders

Group CBT, Norway

CBT group vs. mindfulness group therapy (Nesset et al., 2020)

Model CBT (group)

15-week manualized group CBT compared to waitlist control (Palmstierna et al., 2012)

Randomized control trial

Randomized 17-session controlled trial individual and group CBGT vs. 9-session individual and group MBSR

BIPs in general effective at reducing IPV and general offense recidivism by official reports but not by survivor reports. Significant effect size for quasi-experimental studies but nonsignificant for RCTs Substantial reduction in physical violence found in both groups (baseline to follow-up change CBGT = 0.85 to 0.08, MBSR = 0.88 to 0.19)

26 men with 15 immediate treatment and 11 waiting list

All self-reported IPV was significantly reduced postintervention. No difference in waiting list vs immediate treatment group

None

Lack of a significant treatment effect. Efficacy rate of 42% on recidivism. Weighted mean effect sizes between d = 0.18 and d = 0.47 for couple reports and official reports respectively on recidivism.

Outcomes d = 0.12 across studies

1.5 years to 7 years across studies

125 participants with 3, 6, 9, and 12 month 67 in CBGT and follow-ups 58 in MBSR; 56 partners

Meta-analysis 1 experimental and 2 Meta-analysis (Cheng et al., 2021) quasi-­experimental studies

Meta-analysis 3 studies: 2 6–30 months quasi-­experimental, 1 across studies experimental

Meta-analysis (Arias et al., 2013)

Follow-up post-Tx 6–18 months across studies

Study design Sample N Meta-analysis 5 quasi-­experimental studies

Research studies Meta-analysis (Babcock et al., 2004)

Court-mandated male offenders

Court-mandated male offenders

Male perpetrators voluntarily seeking treatment

Voluntarily treatment-seeking male IPV perpetrators

Data not provided

Data not provided

14.5% CBGT, 15.1% MBSR

37 men initially recruited, 9 dropped out after recruitment but prior to treatment

(continued)

Population Court-mandated male offenders

Dropout rate 18–60% across studies

Mutual violence intervention

12-week individual SADV vs. IDC (Easton & Crane 2016) 12-week gendered groups focused on relationship skills, emotional awareness, and parenting (Wray et al., 2013)

6 months

SADV approach (38 men) vs. TSF approach (37 men)

Randomized 12-week SADV control trial group vs. TSF group (Easton et al., 2007)

Substance abuse and domestic violence CBT 63 participants: 29 SADV and 34 IDC

12 months 92 participants; neither partner completed in 10 cases, man alone in 12, woman alone in 20, and both partners in 50 cases

Randomized control trial

Single group design

6 months

2 years

178 participants: 91 CBT and 87 process oriented

Randomized 20-week group control trial devoted to processing past traumas and mutual support (Saunders, 1996)

Psycho­ dynamic processoriented group therapy

Follow-up post-Tx 3, 6, 9, and 12 month follow-ups

Research studies Study design Sample N 42 men with 21 ICBT 20-session ICBT vs. Randomized controlled trial and 21 GCBT GCBT (Murphy et al., 2017)

Model Individual (ICBT) vs. group CBT

Table 8.1  (continued)

Substance-­ dependent males with co-occurring IPV Mutually violent couples

17%

SADV had mean of 1.1 total violent episodes, and DC condition q mean of 11.1 violent episodes at follow-up Lowest recidivism rates when 8.3% both partners completed treatment

Mutually violent couples

Male offenders

24%

20%

Population Male IPV perpetrators

Dropout rate 14% GCBT

Outcomes Treatment uptake and attendance significantly higher in ICBT vs. GCBT, but GCBT demonstrated equivalent or greater benefits. Similar significant reduction in IPV and injuries across conditions for self-reports; partner reports showed greater improvement for GCBT No differences overall between CBT and process-oriented group on recidivism; process-oriented group was more effective for men with dependent, and CBT more effective for those with antisocial traits SADV had greater reduction in physical violence and alcohol use frequency compared to TSF

Model Strength at Home

37 of 67 participants completed SAH-M;

132 completed intake 51 attended 9 + sessions and postassessment

Greater reductions in both physical and psychological IPV in self and partner reports compared to TAU. Physical IPV 56% less likely; greater reductions in alexithymia for SAH-M SAH associated with significant pre-to-post reductions in self and partner reports of physical and psychological IPV, type of IPV used, and PTSD symptoms

3 and 6 months

None

135 male veterans and 111 female partners; 67 SAH-M and 68 TAU

51 veterans

Randomized control trial

Single group 12-week SAH group (Creech et al., design 2018)

12-week SAH vs. control group (Taft et al., 2016b; Creech et al., 2017; Berke et al., 2017)

6 and 12 months SAH-C group engaged in less reported physical and psychological IPV at posttreatment and follow-ups, no differences on relationship satisfaction

69 male service members or veterans + their female partners; 37 SAH-C and 32 SP

Randomized RCT of 10-week group SAH-­Couples control trial vs. supportive prevention control group (Taft et al., 2016a)

40.5% SAH-C completed 34.4% of SP

39% Significant reductions in psychological aggression at postintervention and follow-up for veterans and significant others. Significant improvement in relationship adjustment and PTSD symptoms

3 months

70 veterans and their loved ones

Dropout rate 25% of those who started treatment

Single group design

Outcomes Significant reductions in violence postintervention and at follow-up

Cohort study of 10-week SAHFriends and Families (Hayes et al., 2015)

Follow-up Sample N post-Tx 6 months 14 participants: 6 completed, 2 dropped out, and 6 failed to start

Study design Single group design

Research studies Pilot study with 14 individuals (Taft et al., 2013)

(continued)

Military men with PTSD

Male military veterans with and without PTSD

Male military members or veterans with and without PTSD

Male military veterans

Population Military men with PTSD

Randomized Pilot study comparing 12-week control trial PSBCT, BCT, and individual-based treatment (Lam et al., 2009)

Parent Skills with Behavioral Couples Therapy/ PSBCT (Lam et al., 2009)

6 months 40 couples: in 19, both partners participated in the multicouple group; in the remaining 21, only the male partner participated 12 months 43 couples received BCT and 43 individuals received individual treatment

Single group design

Couples therapy vs. Randomized control trial individual therapy (BCT; Fals-Stewart et al., 2002)

75 couples recruited; 37 completed treatment and were included in analysis

Randomized control trial

Military population

Married or cohabitating individuals

Not reported

14%

Fathers with alcohol use disorders

Married couples experiencing husband-to-wife partner aggression 51%. No significant difference by group

No significant differences across treatment format; indicating that high levels of psychological and physical aggression signify poor prognosis for both treatments Attrition rate not reported; indicated “majority were violence free”

Lower violence scores in couples treatment for patients with comorbid substance abuse

Population Community couples who self-refer

Dropout rate 50% gender specific; 45% conjoint; 47% overall

Outcomes Improvements in husbands taking responsibility for aggression and in marital adjustment in both groups. No difference between groups in recidivism, 74% recidivism overall

10% across the 6 and 12 months PSBCT comparable to BCT on 30 males, their three treatments substance use and partner female partners and a violence and larger effect sizes on child aged 8–12 years parenting and CPS involvement

12 months

14-week genderspecific vs. conjoint treatment group (Woodin & O’Leary, 2006) Evaluation of multicouples Group approach in IPV military couples (Neidig, 1986)

Follow-up post-Tx 12 months

Sample N 74 IPV couples: 30 gender-specific treatment vs. 44 conjoint treatment

Study design Randomized control trial

Research studies 14 sessions of gender-specific group vs. conjoint treatment group (O’Leary et al., 1999)

Behavioral Couples Therapy (BCT)

The domestic conflict containment program

Model Physical Aggressive Couples Treatment (PACT)

Table 8.1  (continued)

73% of Duluth/ CBT completed treatment vs. 61.1% of ACTV

3466 men: eight participants had died during the 5 years

23 incarcerated DV offenders who failed to complete community based BIP

Randomized control trial

Single group design

8-week, thriceweekly 2-hour group ACTV (Zarling et al., 2019)

12 months

Experiential avoidance decreased 0% significantly over course of treatment. 1 out of 22 participants had a domestic assault charge in 1-year follow-up

Results consistent with first study: As above 5 years following initial ACTV group less likely to acquire any violence or DV charges, but study no difference between groups in general criminal charges

Significantly fewer ACTV participants were arrested for DV (3.6% vs. 7.0%), and any other charges during treatment and 12-month follow-up

Population Couples who choose to stay together after situational couple violence

(continued)

Noncompliant men incarcerated for domestic violence

As above

Men arrested for domestic assault and courtmandated to a BIP

36% for ACT vs. Mental health 41% for control treatment-seeking males and females, who had engaged in at least 2 acts of IPV

Dropout rate An unspecified number of couples dropped out after phase 1 of treatment

12 months

5-year follow-up of 2019 ACTV vs. Duluth/CBT study (Zarling et al., 2020)

24-week 1.5–2-hour Randomized control trial group ACTV vs. equivalent Duluth/ CBT combination treatment (Zarling et al., 2019)

Outcomes Men in both groups reported a significant reduction in physical and psychological IPV; men only in the multigroup format reported an increase in relationship satisfaction First ever study of ACT; showed that ACT group had significantly greater declines in both psychological and physical aggression at posttreatment and follow-up

3474 men: 843 ACTV and 2631 Duluth/CBT

101 male and female 3 and 6 months participants (68% female): 50 ACT and 51 control

Randomized control trial

12-week 2-hour group ACTV vs. equivalent support-and-­ discussion control group (Zarling et al., 2015)

Acceptance and Commitment Therapy (ACT)/ Achieving Change Through Values-Based Behavior (ACTV) (Zarling et al., 2015)

Follow-up post-Tx 2 years

Sample N 16 couples received multicouple therapy and 14 couples received individual couples therapy

Research studies Study design Randomized Multicouples control trial therapy vs. individual couples therapy (Stith et al., 2004)

Model The Domestic Violence Focused Couples Treatment

None

373

Single group F4C delivered individually to child design protection involved fathers (Stover et al., 2020)

3 months

Follow-up post-Tx 6 months

3 months

Sample N 115 situationally mutually violent couples from a community sample: 62 CHRP and 53 control group 15 received FF4 and 9 received IDC

62 (33 F4C vs. 29 PE)

Randomized control trial

Study design Randomized control trial

Randomized 16 session individual F4C (12 control trial residential and 4 outpatient booster) vs. 16 session individual parent education (PE; 12 residential and 4 outpatient booster) (Stover et al., 2019)

Research studies 22-week multicouple group program vs. no-treatment control group (Bradley & Gottman, 2012) Fathers for 16-week F4C Change (F4C) individual treatment vs. IDC (Stover, 2015)

Model Creating Healthy Relationships Program (CHRP)

Table 8.1  (continued)

20%

Dropout rate Control 39.6% CHRP 32%. No difference between groups

Significantly reduced IPV and children’s exposure to conflict, improved father emotion regulation and reflective functioning

26%

Significantly more improved PE group higher emotion regulation scores for F4C completion rates group and reduced relapse than F4C group following treatment compared to the PE group.

Outcomes CHRP increased use of healthy relationship skills and satisfaction. Significant reductions in psychological abuse and conflict but no significant difference in physical violence reduction Trend toward greater reductions in IPV for FF4; comparable reductions in substance misuse; significantly improved father– child interactions for F4C

Fathers of children under 14 referred by child protection for IPV

Fathers of children under 18 in 6-month residential treatment for substance misuse

Fathers with co-occurring IPV and substance misuse

Population Low-income, situationally violent couples

Single group design

17-session group fathering intervention (McConnell et al., 2017)

4 weeks after treatment

14 participants

Single group design

Retrospective review of outcomes over 2 years

53 group participants None

85 in Caring Dads, 100 in waitlist

6 months after 271 evaluation program participants; 66% fathers, 26% partners, completion 8% children

Follow-up Sample N post-Tx 98 group participants None

Single group design

Quasi Caring Dads experimental intervention vs. waitlist (Scott et al., design 2021)

Study design Single group design

Research studies 17-session group fathering intervention (Scott and Lishak, 2012)

Strong Fathers 20-session group fathering intervention (Pennell et al., 2014) 12–20 week Mindfulness intervention and (Wupperman et al., Modification 2012) Therapy (MMT)

Model Caring Dads: Helping fathers value their children, Canada

Fathers who have exposed children to IPV or maltreatment Only fathers who completed intervention included in the Caring Dads group Data not provided

Intervention associated with significantly greater contact between fathers and child protection, and lower rates of father re-referral

(continued)

Men with a history of IPV but no protective order against children Women w/ substance dependence + IPV

Fathers who have exposed children to IPV or maltreatment

Only fathers who completed intervention were analyzed

Fewer reports of domestic abuse incidents; father reports indicated reduced parenting stress and improved interactions with children; children and partners reported positive changes in fathers’ behavior

Child protection data showed extensive decrease in families assessed with child protection findings and household domestic violence Significant decrease in the number 7% of days substance use and use of physical aggression posttreatment

Population Fathers who have exposed children to IPV or maltreatment

Dropout rate Only fathers who completed intervention were analyzed 47%

Outcomes Statistically significant change in fathers’ over-reactivity and hostility to child misbehavior, and respect for their partner’s commitment and judgement.

STOP and change direction

Model The Contexto Programma Spain

Research studies 30-week group- 7 modules at the individual, interpersonal, situational macrosocial level (Romero-Martinez et al., 2016) 20-week individual and group sessions (Mennicke et al., 2015)

Table 8.1  (continued)

5 and 7 years 506 male offenders with 253 in the treatment group and 253 matched individuals in no-treatment controls

Randomized control trial

Follow-up post-Tx Six follow-up sessions every 3 months – 18 months total

Sample N 116 participants with 55 in the high alcohol (HA) and 61 in the low alcohol (LA) groups

Study design Single group design

Population Male IPV perpetrators sentenced to less than 2 years in prison without other prior arrest history Imprisoned male IPV perpetrators

Dropout rate 196 participants initially, 80 did not complete program

Only treatment No significant differences in 5completers and 7-year reincarceration rates between groups. Positive attitudes assessed toward women significantly increased and criminal thinking decreased

Outcomes Postintervention, there were improvements in cognitive empathy and flexibility. Smaller improvements and higher recidivism risk for HA group than LA group – Alcohol use interferes in cognitive change

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there is insufficient evidence to support their almost universal use, and there are movements toward developing alternative models. One of the more recently developed group interventions, Achieving Change Through Values-Based Behavior (ACTV), is based on Acceptance and Commitment Therapy (Zarling & Berta, 2019). It promotes the acceptance, mindfulness, and psychological flexibility of participants to engage them in accepting thoughts they find aversive while promoting behavior that meets their values. Studies so far have demonstrated ACTV’s efficacy in reducing aggression and recidivism (Zarling et  al., 2019) making it a promising group alternative to Duluth and standard CBT approaches. Strength at Home (Taft et al., 2013) and Substance Abuse and Domestic Violence (Easton et al., 2007) are two specialized CBT-based group interventions that focus on trauma theory and the intersection of violent behaviors and substance misuse, respectively, with evidence to support significant reductions in IPV for both programs. Strength at home has been implemented with military populations, and SADV has been used with those who have co-occurring IPV and substance misuse behaviors (typically referred by the courts following arrest for one or both issues). Outside of group approaches, there also exist couple interventions—one of the more widely known of these is the Domestic Violence Focused Couples Therapy (Stith et al., 2011). Focusing on situational conflict and mild to moderate violence between couples, it can take a group or individual couple approach to solution-­ finding and ending violence for couples who wish to stay together. Research has shown reductions in violence for both the individual and group formats (Stith et al., 2011). Behavioral Couple Therapy has also been found to reduce IPV for men with co-occurring substance misuse (Fals-Stewart et al., 2002). There are two approaches with multiple studies that specifically address families and parents who use family violence: Fathers for Change (Stover, 2013) and Caring Dads (Scott & Lishak, 2012). The latter is a group parenting intervention for fathers who have used violence against their partner or child, targeting their behavior and improving understanding of their children’s needs. It includes case collaboration with their partner, while highlighting the importance of the partner’s and children’s safety. Studies thus far reveal significant improvement in fathers’ hostility and reactivity toward children, respect for their partner, and lower rates of rereferral (Scott et al., 2021; Scott & Lishak, 2012). Fathers for Change (F4C) also focuses on the father–child relationship but uses an individual therapy format and extends this to include treatment sessions with the child and co-parent when safe and appropriate. Treatment utilizes a phased approach beginning with assessment to understand the individual needs of the father and how his childhood history in his own family has shaped his current functioning as a father and partner. It targets reflective functioning and emotion regulation to reduce IPV and child maltreatment. Evidence shows F4C produces reductions in IPV, substance misuse, children’s exposure to conflict, improved father emotion regulation, reflective functioning, mental health symptoms, and father–child interactions (Stover, 2015; Stover et al., 2019, 2020). No interventions were found that address mothers’ use of IPV behaviors specifically.

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Overall, there is a trend toward shifting from standard, universalized group interventions based on power/feminist theory toward more assessment and delivery of individualized interventions that target the specific circumstances and needs of each person or couple where IPV occurs (e.g., military veterans with trauma, those with co-occurring substance misuse, fathers). Still, more research is needed to further the evidence base for the effectiveness of such programs. Many of the programs do not have enough large-scale studies or implementation to support efficacy. Many models have only one or two small scale studies. Newer models that are promising in this regard are ACTV, Safe at Home, Caring Dads, and Fathers for Change.

4 Interventions for Children Who Have Witnessed IPV Over the last two decades, there has been substantial progress in the development of interventions for children who have experienced IPV. There are now multiple evidence-­ based interventions that have been developed, many designed to target the mediators of the association between IPV and child outcomes. The most widely available interventions and those with the most evidence for their effectiveness will be reviewed. The two most widely available interventions are Trauma Focused-­Cognitive Behavioral Therapy (TF-CBT; Cohen et  al., 2017) and Child Parent Psychotherapy (CPP; Lieberman et al., 2015). Both have been tested in multiple randomized controlled trials indicating improved nonoffending caregiver and child improvements in PTSD symptoms. Both are available across the United States and internationally. TF-CBT is a conjoint child and parent psychotherapy model for children who are experiencing significant emotional and behavioral difficulties related to traumatic life events, which can include IPV. The therapist meets with both the nonoffending caregiver (which may be the parent who is a survivor of IPV used by the child’s other parent) and the child in both parallel and conjoint sessions. TF-CBT is a components-­based hybrid treatment model that incorporates trauma-sensitive interventions with cognitive behavioral, family, and humanistic principles. It has been used with children as young as age 3 and up to 18. CPP is a dyadic treatment where the child is seen together with their primary caregiver. It is for very young children from infancy through age five. CPP was developed specifically for children who had witnessed IPV between their caregivers and has since been applied to other trauma exposure types. CPP is an attachment-­ focused intervention that examines how trauma and the caregivers’ relational history affect the caregiver–child relationship and the child’s developmental trajectory. A central goal is to support and strengthen the caregiver–child relationship as the means to help the child recover. Targets of the intervention include caregivers’ and children’s maladaptive representations of themselves and each other and interactions and behaviors that interfere with the child’s mental health. Over the course of treatment, the clinician helps the caregiver and child to create a joint narrative about

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the traumatic experiences and identify and address traumatic triggers that generate dysregulated behaviors (like aggression and tantrums) and emotions. In addition to these two widely available and well-studied interventions, there are some other interventions that have been developed that are also becoming more widely available with increasing research evidence: Kids’ Club and Moms’ Empowerment (Graham-Bermann & Miller, 2013), Alternatives for Families-­ Cognitive Behavioral Therapy (AF-CBT; Kolko, 1996), and Child and Family Traumatic Stress Intervention (CFTSI; Epstein et al., 2017). The Kids’ Club and Moms Empowerment are two programs designed to be provided in parallel and are most effective when both the mother and child participate in the group intervention. Kids Club is a preventive 10-week group intervention program designed to first increase children’s sense of safety and create a common vocabulary of emotions and responses to violence. Later sessions focus on who is responsible for violence, managing emotions, family relationship paradigms, and conflict and its resolution. The parallel Moms’ Empowerment group provides connections for mothers in a supportive group and aims to empower mothers to discuss the impact of violence on their children, provide a safe space to discuss parenting worries, and build parenting competence. AF-CBT is designed to reduce or prevent the impact of exposure to child or family anger, aggression, and/or child physical abuse. AF-CBT (originally named Abuse-Focused Cognitive-Behavioral Therapy) teaches parents and children intrapersonal and interpersonal skills to enhance self-control, promote positive family relations, and reduce violent behavior. These skills include anger and anxiety management, how to challenge misattributions to support flexible thinking, child social skills, effective and safe discipline strategies, and healthy family communication and problem-solving skills. These skills seek to improve self-control, help families get along better, and maintain a safe and secure home environment. CFTSI is a brief early intervention model for children and adolescents aged 7 through 18 that is intended to be implemented in the peritraumatic period (within 45 days of exposure or disclosure of a potentially traumatic event). The goal of this family-strengthening model is to improve the nonoffending caregiver’s ability to support their child following exposure to trauma like witnessing IPV. By raising awareness of the child’s symptoms, increasing communication, and providing skills to help master trauma reactions, CFTSI aims to reduce symptoms and prevent chronic PTSD. What is common across these interventions is a focus on both the primary caregiver and child. Studies have shown that engagement of parents improves both their posttraumatic symptoms and those of their children (Cohen et al., 2011; Hahn et al., 2019; Lieberman et al., 2005). Further increasing parent support of the child and their ability to talk about the past IPV exposure is also a common theme across these interventions both with very young children in CPP and with older children and adolescents in the other interventions. Coregulation of emotions and arousal and increased parent and child reflective functioning are also important characteristics of these interventions. All focus on helping parents think about the mental states, feelings, and symptoms of their children to better support recovery. TF-CBT and

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CPP also focus heavily on the experiences and responses of the caregivers to provide processing and support to caregivers related to their own responses to the IPV. These connect nicely to the factors identified as supporting recovery and preventing long-term poor outcomes for children: parental support and sensitivity through good mentalization skills, secure attachment, and well-developed emotion regulation skills.

5 Recommendations, Future Development, and Implications for Practitioners and Courts The field of interventions for families experiencing IPV has grown substantially over the last several decades. Large bodies of literature on the impact of IPV exposure on children, how trauma impacts child development, and increased development of targeted intervention for both children exposed and for those who use IPV behaviors have emerged. Still, there is a significant amount of work to do to further refine and test interventions to reduce and prevent IPV, but based on current knowledge, there are interventions that can help. Unfortunately, many communities do not have providers trained to offer evidence-based or evidence-informed intervention. There needs to be greater movement to disseminate and incentivize use of interventions that are shown to work for subpopulations of those who cause harm. States and courts continuing to mandate group-based interventions that have not been widely effective are not helpful and are a waste of precious resources. Following arrests or child protection involvement, assessment is needed to understand a particular person and family to best make recommendations for appropriate intervention. This then allows provision of services that target the root cause of the violence and acceptable intervention approaches for the individual. This could be unresolved trauma or undiagnosed mental health diagnoses. It could be that the person has a co-occurring addiction or is suffering from extreme stress due to lack of social and vocational supports. There are individuals who have a strong negative reaction to participating in groups and will not open up or participate well in this setting. Conversely, there are others who are averse to the idea of an individual intervention and are better suited to working in a group. The ability to select from several possible intervention programs and find those that best fit will result in much better outcomes for families. The National Child Traumatic Stress Network (www.nctsn.org) funded by the Substance Abuse and Mental Health Administration has provided funding to agencies and programs across the country to provide trauma-informed assessment and intervention for families who have experienced trauma including IPV. These efforts have focused on dissemination of interventions like TF-CBT, CPP, CFTSI, and AF-CBT.  More initiatives like these and integration of training in best practice intervention for those who cause harm are needed. Communities that want to provide programs like ACDV, SADV, Caring Dads, and Fathers for Change need mechanisms to ensure appropriate training and implementation of these interventions.

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This may require advocacy and policy changes at the local and state levels to ensure access to appropriate services.

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Chapter 9

Interventions to Prevent Violence in the Family Daniel J. Whitaker, Arshya Gurbani, and Nikita Rao

Violence has been recognized as an important public health and social problem (Krug et al., 2002). Much of violence occurs within family units with the two most common forms of family violence being child maltreatment (CM) and intimate partner violence (IPV). Many prominent health organizations including the U.S. Centers for Disease Control and Prevention, the National Institutes of Health, the Institutes of Medicine, and the World Health Organization have focused on these two forms of family violence because of their frequency and long-lasting detrimental impacts. The field has called for both programmatic and policy responses to CM (e.g., Shonkoff, 2016) and IPV (Niolon et al., 2017), and there are strong calls for primary prevention of violence globally (Krug et al., 2002). The goal of this chapter is to broadly review interventions targeted to these two forms of family violence. CM and IPV will be reviewed separately because they are typically studied separately and have different intervention methods, despite the fact that they are strongly related and often co-occur (Grasso et al., 2021). For each, we describe the most prominent types of interventions, and the evidence for their support. Importantly, we focus on primary and/or secondary preventive interventions that occur largely within family units. We do not attempt to cover tertiary interventions, such as trauma treatments, that may attempt to alleviate the negative impacts of violence.

D. J. Whitaker (*) · A. Gurbani · N. Rao Georgia State University, School of Public Health, Atlanta, GA, USA e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 P. Sturmey (ed.), Violence in Families, Advances in Preventing and Treating Violence and Aggression, https://doi.org/10.1007/978-3-031-31549-7_9

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1 Child Maltreatment Child maltreatment typically includes act of commission including physical, psychological, and sexual abuse, and acts of omission including various forms of neglect. Here we focus on physical abuse and child neglect, the two most common forms of maltreatment (U.S.  Department of Health & Human Services, 2019). Though child sexual abuse receives a great deal of attention in the literature (Behl et al., 2003), it represents a relatively small proportion of child maltreatment cases (U.S. Department of Health & Human Services, 2019). Generally, physical abuse is defined as the intentional use of physical force against a child that results in, or has the potential to result in, physical injury (Leeb et  al., 2008). Neglect is defined broadly as a failure to provide for a child’s basic physical, emotional, or educational needs or to protect the child from harm (Leeb et al., 2008), and thus there are multiple forms of neglect (e.g., supervisory neglect, environmental neglect, medical neglect, and educational neglect). In the United States, child neglect is the most common form of maltreatment, accounting for up to approximately 75% of official reports (U.S. Department of Health & Human Services, 2019) but has received relatively little attention (Dubowitz, 1994; McSherry, 2007). The most common interventions for maltreatment are directed at parents because child maltreatment is in most cases a deficit in parenting. Modern theoretical approaches to maltreatment are based on social–ecological theories that describe risk factors for maltreatment at levels of the social ecology including individual, familial, community, and societal risks (Belsky, 1993; Cicchetti & Lynch, 1993; Garbarino, 1977). However, such broad theoretical perspectives are often not useful for specific intervention delivery. Parent training has been identified as a key focal point for intervention to prevent and address maltreatment (Barth et  al., 2005), though it is clear there are many other risk factors for maltreatment besides poor parenting skills. Behavioral models (Lutzker et  al., 1998) and attachment-based models (Dozier et al., 2016) have been the primary focus of parenting models that address maltreatment. Several recent meta-analyses have examined whether parenting programs generally have an impact on maltreatment (Chen & Chan, 2016; Euser et al., 2015; Lundahl et  al., 2006; van IJzendoorn et  al., 2020), and whether the inclusion of specific intervention components leads to impact (Filene et al., 2013; Gubbels et al., 2019; Van der Put et al., 2018). Unfortunately, there is little clarity on the answers to these questions. Reviews and meta-analyses come to slightly different conclusions depending on the types of studies included, the populations targeted, and perhaps most importantly, the outcomes included in the results. For example, reviews by Chen and Chan (2016) and van IJzendoorn et al. (2020) reported modest impacts of interventions on child maltreatment. Euser et al.’ (2015) review examining only randomized trials suggested a less optimistic picture with small effects that disappeared when considering potential publication bias. One key finding from Euser et al. (2015) was that interventions that focused on the training of parenting skills

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had larger effect sizes than those that focused only on supporting parents without a specific skill training. In an attempt to understand what factors drive the impact of parent training programs on child maltreatment, Gubbels et  al. (2019) conducted an extensive meta-­analysis examining whether a series of key program components were related to greater effects. Programs were coded for structural elements (length, format), program components (e.g., parent–child communication, parental responsivity, positive reinforcement, problem solving, stress management) and delivery techniques (modeling, role playing, video feedback, homework, etc.), which were examined as effect moderators. Overall, a modest program impact on CM was found (d = 0.41), and very few effect modifiers were identified. The presence of any particular component was not related to greater impact. However, in a few cases, programs that omitted specific components—for example, problem-solving skills, improving parents’ personal skills—had larger effect sizes than programs with those components. With the overall impact in question, it is critical to look at the two broad classes of parenting programs: behavioral training programs and attachment-based programs.

Behavioral Parent Training Interventions Behavioral parenting interventions (BPT) were first developed in the 1970s to address child behavior problems and break the “coercive cycle” of parent–child interactions (Patterson, 1982). BPTs were applied to child maltreatment prevention as it was observed that maltreating parents often have the same difficulties as parents of children with conduct problems. Namely, a poor relationship and difficulty structuring children’s activities and behaviors may lead to children misbehaving and parents’ use of coercive discipline such as physical punishment, which in turn could spiral into more severe psychological and physical abuse (Urquiza & McNeil, 1996). The typical goals of behavioral parenting training for maltreating parents are to strengthen the parent–child relationship and to teach more positive ways to structure and positively reinforce behavior to prevent misbehavior and the escalation and potential abuse. Next, we describe three prominent BPTs with demonstrated evidence at reducing maltreatment. Triple P The Triple P or Positive Parenting Program uses behavioral strategies to enhance parenting skills to promote positive, nurturing, and nonconflictual parent–child interaction with the goal of promoting children’s social, emotional, and behavioral competencies (Sanders et al., 2003). Triple P is a set of interventions that vary in intensity and duration that can be used in a systemic setting to achieve broad public health impact (Prinz, 2014; Sanders, 2008). Triple P offers five levels of intervention,

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beginning with Level 1, a communication and media campaign, to Levels 2 and 3 that are brief single- or multisession consultative interventions, to Level 4 (standard Triple P), an 8- to 10-session individual or group parenting class designed for children with detectable problems, to Level 5, which augments Level 4 with interventions for additional risk factors such as poor parental communication or depression (Sanders et  al., 2003). Most studies of Triple P have included only a single level (but see Sanders et al., 2000), but the availability of a tiered system of interventions provides flexibility for providers and systems to coordinate interventions (Sanders et al., 2003). Triple P emphasizes several principles of positive parenting including: (1) ensuring a safe and engaging environment, (2) creating a positive learning environment, (3) using assertive discipline, (4) having realistic expectations as a parent, and (5) taking care of oneself as a parent (Sanders et al., 2003). The model also emphasizes several core parenting skills including observation of behavior, parent–child relationship enhancement, reinforcing desirable behavior, teaching new skills, managing misbehavior in a noncoercive way (e.g., planned ignoring and time out), preventing problems in high-risk situations, and parent mood management (Sanders et  al., 2003). Finally, another core component of the model is the multidisciplinary approach; the Triple P system was designed to be used by a range of public health professionals within the context in which they encounter parents. For example, a nurse in a pediatric practice may deliver a brief (Level 2/3) intervention for parents with a specific challenge, whereas a community mental health provider may deliver a more intense intervention (Level 4) for parents seeking help for more in-­depth issues. Many randomized trials of Triple P have shown that the program improved parenting behaviors and reduced negative child behavior (Nowak & Heinrichs, 2008; Thomas & Zimmer-Gembeck, 2007). These results seem to hold across modalities of Triple P with individual, group, and self-directed modalities showing positive impact, though the strength and consistency of the effects varied for specific outcomes and targets. For example, parents’ reports yielded larger effects than observational measures, and effects on mothers were larger than for fathers (Nowak & Heinrichs, 2008). One large Triple P trial focused specifically on child maltreatment outcomes used administrative data to examine the impact of the intervention in 18 counties in South Carolina, matched and randomly assigned to receive the Triple P system of interventions or not. In each county randomized to Triple P, trainers trained the workforce including counselors/therapists, parent educators, child-care staff, and nurses to deliver Triple P to families. Over the course of the study, over 600 service providers were trained, and a media communication campaign (e.g., newspaper articles, radio spots, and community events) was implemented in the intervention counties. At the end of the study period, compared to control counties, the Triple P counties were found to have reductions in substantiated cases of maltreatment, out-of-home placements, and hospitalization and emergency room visits due to child maltreatment (Prinz et al., 2009, 2016), and all effect sizes were large in magnitude (all ds over 1.1–1.2). Triple P is one of the most widely disseminated parenting programs in the world.

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SafeCare The SafeCare© model was developed by Lutzker (Lutzker & Bigelow, 2002) to focus on three primary behaviors that are proximal antecedents to child physical abuse and neglect: parent–child interactions, home safety, and child health. SafeCare targets parents of children aged zero through 5 years and focuses on these three content areas to promote positive interactions between parents and children, promote parents’ use of structure and noncoercive behavior management techniques, reduce the home hazards to reduce environmental neglect and intentional injuries, and improve parents’ ability to care for their children when sick or injured. With its focus on the home environment and child health care skills, SafeCare is one of the only behavioral programs that directly targets child environmental and medical neglect. SafeCare is delivered in the home or natural environment to promote skill generalization. SafeCare is typically delivered by Bachelor’s degree, nonclinical providers, which makes SafeCare a good fit for child welfare systems, who frequently employ this level of provider. Each of the three SafeCare modules begins with a structured observational assessment of behaviors that need to be addressed. This includes, for example, an observation of parent–child interactions during play and routine daily activities, a home assessment for safety hazards, and an assessment of how parents assess and treat common illnesses and injuries. After the assessment, a series of sessions are devoted to teaching parents the new skills, and each module ends with another assessment to confirm skill uptake. As with Triple P, the basis for the parent–child interaction module of SafeCare is planned activity training (Lutzker et al., 1998). Several small studies validated the content and initial effectiveness of each of the three modules, including parent–child interactions (Lutzker et  al., 1985), home safety (Barone et al., 1986), and child health (Delgado & Lutzker, 1988). Randomized trials have demonstrated impacts of SafeCare on parenting skills and parenting stress (Carta et al., 2013; Whitaker et al., 2020) and maltreatment rates (Chaffin, Hecht, et al., 2012b). In one of the largest trials of a parenting program within a child welfare system aimed at preventing maltreatment recidivism, service delivery regions within the state of Oklahoma child welfare system were randomized to either adopt SafeCare as part of their family preservation services or to continue to conduct services as usual. Findings from over 2200 families who were followed on an average for 7 years indicated that SafeCare reduced child maltreatment recidivism compared to usual service by about 25% (Chaffin, Hecht, et  al., 2012b). Additional analyses showed the impact was nearly identical for a sample of American Indians (Chaffin, Bard, et al., 2012a), making it one of the few programs with demonstrated impact among a native population.

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Parent–Child Interaction Therapy Parent–child interaction therapy (PCIT) is a clinical model designed to address child behavior problems (Eyberg, 1988). PCIT was developed for parents with children between 2 and 7 and includes two primary components: (1) a child-directed component in which parents are taught to interact with children in a positive, supportive manner using positive attention and social reinforcers to improve the parent–child relationship; and (2) a parent-directed component in which parents are taught to manage their child’s behavior using specific discipline techniques that are consistent and predictable, thereby reducing children’s disruptive behaviors. A hallmark of PCIT is that parents and children are treated together with live coaching from the therapist. Typically, the therapist observes interactions through a one-way mirror and communicates with the parent via a radio and earpiece. In this way, the therapist can teach parenting skills in real time, ensure they are performed correctly, and assist parents in responding to the child. PCIT has been the focus of a number of randomized trials with parents of children with disruptive behavior problems, and those trials have demonstrated a strong impact on improved parenting behaviors and reduced negative child behaviors (for review, see Thomas & Zimmer-­ Gembeck, 2007). PCIT was adapted for use among families within a history of physically abusive behavior (Urquiza & McNeil, 1996). Adaptations of PCIT for use with maltreating parents include an emphasis on identifying developmentally appropriate behaviors, praise, and an additional emphasis on discipline practices other than corporal punishments (Chaffin et al., 2004). Trials of PCIT with families in the child welfare system have shown some positive effects. Chaffin and colleagues conducted two randomized trials with PCIT (Chaffin et al., 2011, 2004), comparing it to usual services. In one study, families reported for physical abuse were randomized to (1) PCIT alone, (2) EPCIT, which consisted of PCIT plus individualized enhanced services that focused on issues of substance use, depression, and family or domestic violence if those problems were present, or (3) standard community-based parenting groups. Parents receiving PCIT alone were significantly less likely to be re-­ reported for physical abuse than standard parenting (19% vs. 49%, p = 0.02) and trended toward being less likely for physical abuse than the EPCIT (19% vs. 36%, p = 0.13). The impact of PCIT on re-reports was mediated by reductions in negative parent–child interactions (Chaffin et al., 2004). It may seem counterintuitive that PCIT alone nominally outperformed the EPCIT group. The PCIT and EPCIT did not differ in the amount of PCIT received, but there was a nonsignificant trend such that PCIT parents were more likely to meet skill mastery criteria than EPCIT parents. Other reviews have indicated that adding ancillary services to parenting programs generally has a negative impact on the improvements in parenting behaviors; that is, greater improvements in parenting are observed when parenting programs are presented without additional services (Kaminski et  al., 2008). This is a critical point in thinking about the delivery of parenting services to address child maltreatment. There is a prevailing belief among child protection systems that parents must receive a large bundle of services. A

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recent task force report from the American Professional Society on the Abuse of Children on evidence-based service planning identified “focus and parsimony” as a core principle so that families should be given only as much intervention as necessary (Berliner et  al., 2015). Other reviews of parenting have noted that “less is more” in that fewer sessions were more effective at improving parental sensitivity (Bakermans-Kranenburg et al., 2003).

Attachment-Based Interventions The primary goal of attachment-based parenting programs is to promote a secure attachment between parent and child, to avoid disruption by inconsistent and insensitive parenting, and in the most extreme case, by maltreatment (Main & Solomon, 1986). Research consistently shows that maltreated children are more likely to have insecure attachments compared to their nonmaltreated peers (Baer & Martinez, 2006), and parents with insecure attachments are more likely to maltreat their children (Lo et al., 2019). Early attachments are thought to be key in later healthy emotional and interpersonal development, and deficits in attachments have been related empirically to negative mental health, emotional, and behavioral outcomes in children (Fearon et al., 2010; Hoeve et al., 2012; Madigan et al., 2013). Attachment-based models have a very different theoretical focus than behavioral parenting models but have some practical similarities. The basis for most attachment-­ based interventions is a focus on caregiver sensitivity, which is the caregiver’s ability to attend and respond to their baby’s signals of emotional and physical needs (Ainsworth, 1979). There are many different models including Child-Parent Psychotherapy (CPP; Lieberman et  al., 2006), Attachment and Bio-behavioral Catch-Up (ABC; Dozier et al., 2014), Circle of Security (Kim et al., 2018), Minding the Baby (Slade et al., 2020), and the Child First model (Lowell et al., 2011). CPP and the related Infant-Parent Psychotherapy (IPP) is perhaps the best-known attachment-based parenting model and is a treatment for trauma-exposed children under 5 years old (Lieberman & Van Horn, 2005). CPP is a year-long treatment with weekly sessions, and the identified client is the parent–child relationship. The goal of CPP is to improve the parent–child attachment by addressing the parent’s negative mental representation, which can lead to poor sensitivity and responsiveness. In CPP, the therapist provides the parent with corrective therapeutic relational experiences through respect, empathy, and positive regard, and this allows the parent to differentiate past negative mental representations from the current representation of the self and others, particularly the baby. These more positive mental representations of the self and baby allow for more nurturing and responsive parenting. A more behaviorally oriented, attachment-based model is the ABC model (Dozier et  al., 2014). ABC was designed explicitly for parents referred by child protection systems and for children in foster care (Dozier et al., 2009). ABC is a short-term 10-session intervention with an explicit focus on changing behaviors rather than parent’s internal representations, a behavioral orientation found to be

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key in effecting outcomes (Bakermans-Kranenburg et al., 2005). ABC focuses on three specific behaviors that promote secure attachments. First, distressed children should be provided with nurturing care, which requires the parent to properly interpret the child’s cues. Second, the parent should provide a responsive and predictable environment when the child is not distressed. Finally, the parent must decrease behaviors that frighten the child. ABC sessions have a strong focus on skill practice with immediate feedback from the therapist similar to PCIT. Data on how attachment-focused parenting programs affect subsequent maltreatment are continuing to emerge. Such models provide clear benefit to parents and children on outcomes such as secure attachments (Bernard et al., 2012; Cicchetti et al., 2006), parental sensitivity and responsiveness to the baby (Bick et al., 2013), parental distress and trauma symptoms (Lieberman et  al., 2005), and children’s negative emotion (Lind et  al., 2014), including biological measures of stress (Bernard et  al., 2015). However, data on the impact of such programs on future maltreatment is much more limited. One large trial of the Child First model (Lowell et al., 2011) found that the intervention reduced future reports of maltreatment to child protection systems and positively affected a number of other outcomes (behavioral symptoms, language, parent stress, psychopathology). In that study, however, CPP was packaged with a system of care interventions that provided extensive case management services so the impact of CPP was not isolated by the study design. Thus, attachment-based programs have clear positive impacts for attachment and child-related outcomes, but their ability to prevent future maltreatment has not been established.

Early Preventive and Home Visiting Interventions Early intervention systems have been implemented to promote children’s social and emotional development, and to prevent child maltreatment. Though a range of services are part of an early intervention system, one of the core services offered is early home visiting. Home visiting models can begin in the prenatal period or after a child is born and typically focus on both child and maternal health and well-being. Home visiting programs have become increasingly popular as data show improvements on a range of maternal and child outcomes (Filene et  al., 2013; Sweet & Appelbaum, 2004). Home visiting programs typically target maternal and child health, school readiness, and social and emotional functioning as outcomes, and most have the explicit or implicit goal of improving the parent–child relationship and preventing maltreatment. Home visiting programs vary greatly with regard to duration, focus, and onset. Some are very brief (one to three sessions) and others very long (up to 5 years). Some have a narrow focus (e.g., Family, Connects, SafeCare) and others target multiple outcomes (e.g., Nurse-Family Partnership, Parents As Teachers). It is also worth noting that some parenting programs described above are also part of home visiting systems (e.g., SafeCare, ABC, Child First). Space prohibits describing each

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of the models so here we will focus on one of the most well-known models that has impacted maltreatment, the Nurse-Family Partnership (NFP). The Nurse-Family Partnership The NFP program was developed in the late 1970s by Olds and has become widespread across the United States (Olds, 2002, 2006). NFP serves low-income, first-­time mothers who enroll prior to the 28th week of pregnancy, and services continue until the child turns two. Thus, the duration of NFP can be up to 27 months or so. Registered nurses deliver weekly or biweekly home visits to mothers with interventions and frequency of visits varying according to the stage of the model and needs of the mother. The intervention focuses on several domains: prenatal health, sensitive and competent parenting, and early parental life course (pregnancy planning, parental education, and employability). The NFP model is one of the most widely disseminated prevention models in the world, with programs in most US states and many non-US countries. Three randomized trials of the NFP model produced a number of positive impacts on a number of mother and child outcomes. NFP was found to have a positive impact on a range of maternal outcomes including nutrition, smoking, parenting behaviors, workforce engagement, subsequent births, and arrests (see Olds, 2002). Children exposed to NFP had less delinquent behavior, fewer sex partners, and reduced alcohol use (Olds, 2002). With regard to child maltreatment reports, interestingly the initial NFP trial found no impact of NFP on child maltreatment reports until the children were about 4 years old (Zielinski et al., 2009), and effects were sustained to age 15 (Olds et al., 1997). Interestingly, subsequent analyses showed that the preventative effect on child maltreatment was mediated by the impact of the NFP model on subsequent births; mothers with fewer subsequent births had fewer reports of maltreatment. Another nuance of NFP’s impact on child maltreatment is that the impact of the model on maltreatment outcomes appeared to be reduced in the presence of intimate partner violence (Eckenrode et al., 2000). A second NFP trial failed to replicate impacts of NFP on child maltreatment reports to CPS agencies, possibly due to low frequency of reports (Olds et al., 2007), but did replicate many of the other positive findings on maternal and child health outcomes. Other large home visiting programs such as the Parents As Teachers model and Healthy Families America have had many evaluations finding some positive impact on family outcomes. However, preventive effects of those models on measures of child maltreatment have been elusive as meta-analyses show very small overall effect sizes of home visiting programs (Gubbels et al., 2021).

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 ecommendations for Practitioners Regarding R Child Maltreatment Though a wide range of factors present risk for child maltreatment, the best evidence for clinical practice for preventing and addressing child maltreatment comes from research on parenting programs. We can offer the following recommendations. • To prevent or address maltreatment, consider a behaviorally based parenting program. Several programs provide protocols for working with families at risk for, or who have already perpetrated, maltreatment. Many have been broadly disseminated and are widely available. • For parents with trauma, an attachment-based parenting model may be a better fit than a behavioral model. There are little data directly comparing behavioral and attachment-based parenting models, but attachment-based models focus on the parent–child relationship and have a strong focus on the parental traumatic history and ability to respond to the child in a sensitive manner. • To address a broader range of risk factors in a preventive context, broad home visiting models such as NFP and Parents As Teachers can be implemented by systems to serve large numbers of families. • When working with families for whom maltreatment is an issue, consider guidelines for implementing evidence-based programs. In cases of maltreatment, there are usually several issues besides poor parenting that may be addressed (e.g., parent mental health, alcohol and substance use, partner violence, and economic security). A task force report from the American Professional Society on the Abuse of Children on evidence-base planning (Berliner et  al., 2015) suggested that parsimonious treatments that address the most significant problem be implemented first and that families should be given only as much intervention as necessary. There can certainly be a tendency to offer multiple services simultaneously, but reviews of parenting research have noted often that adjunct services can detract from the impact of a parenting program (Kaminski et al., 2008) and that “less can be more” in that fewer sessions were more effective at improving parental outcomes (Bakermans-Kranenburg et al., 2003).

2 Intimate Partner Violence Intimate partner violence (IPV) is defined as physical, sexual, stalking, or psychological aggression directed toward an intimate partner, either current or former (Breiding et  al., 2015). IPV often has serious negative consequences for victims, and these consequences can include physical injury, psychological trauma, and in the most extreme cases, death (Bacchus et al., 2018; Campbell et al., 2002; Stubbs & Szoeke, 2021). In fact, women are more likely to be murdered by an intimate partner than by any other type of perpetrator (Catalano, 2013).

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Interventions for IPV vary according to the outcomes targeted (reduced perpetration, reduced victimization, lessen the impact of IPV, etc.), whether the intervention is intended for use in primary or secondary prevention (i.e., with those already engaged in violence or those not yet engaged), and whether the intervention is mostly intended for the perpetrator or the victim of violence. The intervention literature has drawn clear lines around these distinctions. Primary prevention interventions have focused on adolescents (or younger), are primarily set in schools, and are rooted in developmental theory around teen risk behaviors (Whitaker, Morrison, et al., 2006b; Whitaker et al., 2013). Secondary preventions of IPV have traditionally focused on more serious cases of IPV and have been rooted in the criminal justice literature (Gondolf, 2002). Likewise, interventions focused on perpetrators and victims have been studied separately (Eckhardt et al., 2013), with perpetrator-­ based interventions focusing primarily on men and victim-focused interventions focusing on women; however, data on the nature of IPV suggest these distinctions are not always helpful. For example, data show there is strong continuity in the perpetration of violence against an intimate partner from adolescence to adulthood and common risk factors for dating violence and adult partner violence (Capaldi & Langhinrichsen-Rohling, 2012; Ehrensaft, 2008; O’Leary & Slep, 2003; Whitaker et al., 2009) and that initiation of violence against a partner is common in both men and women (Straus & Gelles, 1995), though women are more likely to be injured than men (Archer, 2000; Whitaker et al., 2007). Because the individually based approaches that are common in the field of IPV intervention generally have not considered relationship dynamics, they may ignore important risk and causal factors for IPV (Ehrensaft, 2008), including dyadic variables that are typically the strongest predictors of violence (O’Leary et al., 2014).

Individually Focused IPV Interventions Understanding the historical context of heightened attention to partner violence is important for understanding the landscape of IPV interventions. Attention to IPV as a problem was first driven by the women’s movement in the 1970s, which framed violence against women in a broader sociological context supporting a patriarchal society (Dobash & Dobash, 1979). The earliest intervention efforts were driven by community-based service providers working with severe cases of partner violence; thus, those efforts targeted male perpetrators of IPV with batterer intervention programs and provided a range of victim services (e.g., shelters and legal assistance) for female victims. Interventions were naturally grounded in feminist theory on the causes of partner violence, its nature and trajectory, and how to resolve it. In the most popular model, termed the Duluth model (Paymar & Pence, 1993), treatments focused on principles of power and control, attitudes about women, and re-­educating men by identifying and rectifying patriarchal attitudes and demanding accountability for behavior. Duluth model interventions dominated the treatment landscape for some time despite limited empirical evidence of their effectiveness (Babcock et al.,

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2004; Eckhardt et al., 2013; Feder & Wilson, 2005). In fact, 43 of 50 US state jurisdictions mandate standards for IPV perpetrator interventions, and many of those standards continue to include elements consistent with a Duluth approach (Richards et al., 2021), which has prompted calls for more evidence-based standards for perpetrator programs (Babcock et al., 2016). The other primary framework prominent in community-based interventions for partner violence is a cognitive-behavioral (CB) framework (Hamberger, 1997; Nesset et  al., 2019). The cognitive-behavioral framework is based on standard cognitive-­behavioral treatment, and thereby attempts to identify and change the thoughts, feelings, and behaviors that may precipitate violent episodes (Hamberger, 1997). CB interventions typically target hostile cognitive biases, emotion regulation skills, communication skills, relaxation training, and problem-solving skills in order to prevent the thoughts and feelings that can lead to abusive behavior. CB interventions for abusive behavior pay special attention to denial and avoidance around violent behavior, taking responsibility, and understanding coercion (Hamberger, 1997). The distinction between Duluth-type and cognitive-behavioral models has become less clear over time as each has incorporated elements of the other (Babcock et al., 2004). Many reviews have been conducted regarding the effectiveness of community-­ based abuser-focused IPV prevention programs at preventing future re-abuse (Babcock et al., 2004; Cheng et al., 2021; Eckhardt et al., 2013; Feder & Wilson, 2005; Travers et al., 2021; Wilson et al., 2021). Most of the studies in these reviews have been evaluations of community-based interventions focused on court-ordered male perpetrators using group-based treatments with either a Duluth model or a CB orientation. Conclusions were generally pessimistic about the findings. For example, Babcock and colleagues’ (2004) review included 22 studies that used either experimental or quasi-experimental designs to evaluate abuser-focused treatment programs to compare Duluth-based treatments with CB treatments. Effect sizes for recidivism or re-abuse were small, no differences were found across treatment types, and less rigorous studies (quasi-experimental) showed larger effect sizes than more rigorous studies. Another review (Feder & Wilson, 2005) published at around the same time included only the 10 most rigorous evaluations using either experimental methods or quasi-experiments with baseline equivalence and examined differences in victim reported revictimization and official police reports of domestic violence. Like the Babcock (2004) review, the Feder and Wilson review (2005) found small overall effects favoring treatment, but variation in effect sizes by design type and outcome type. In particular, the largest effects were found from quasi-­ experimental studies comparing treatment dropouts to completers, a comparison that is dubious at best. An updated review by the same authors led to similar conclusions (Wilson et al., 2021). Smedslund and colleagues’ review (Smedslund et al., 2011) focused on CB treatments and included six studies that used experimental methods to compare CB group treatments to control. Only one of the six studies found a significant effect favoring treatment over control. With these pessimistic findings, the field has shifted in recent years to consider how interventions may need to be tailored for specific types of abusers or to address

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other risk factors. The Risk-Need-Responsivity (RNR) framework (Bonta & Andrews, 2007) from the field of criminal justice provides a broad framework for thinking about tailoring treatment. The RNR framework suggests that one must consider the risks posed by individual-based factors (e.g., antisocial behaviors, cognitions, peers, family, work, and alcohol and substance use), the needs of the perpetrator that may be supporting their current abusive behavior, and the responsivity of an intervention to adapt to the individual’s motivation, abilities, and learning style. Several key variables have been considered in discussions of tailored treatments including perpetrator motivation for treatment, personality characteristics, anger and hostility, mental health and trauma history, and alcohol and substance use (Butters et al., 2021; Murphy & Meis; Yakeley, 2022). Empirical research on this new wave of interventions is just now emerging. One of the focal points receiving much attention is understanding the perpetrators’ motivation and readiness for treatment, and how those motives create fit or lack of fit with a particular type of intervention (Santirso et al., 2020). As has been frequently noted, interventions for perpetrators of IPV are typically mandated after an arrest, and the clients may deny the problem and be resistant to treatment (Heckert & Gondolf, 2000). Recently, several studies have examined how using a motivational enhancement and/or using a stages of change approach to tailor treatments can enhance retention and improve violence-related outcomes. Santirso and colleagues (Santirso et al., 2020) reviewed how motivational strategies have been used in IPV interventions. The review included 12 randomized trials that had employed some strategy to increase motivation as part of treatment, but only 7 of those were included in a meta-analysis because of lack of necessary information. Though there was variation in the types of strategies used, most studies employed motivational interviewing techniques (Miller, 1996) with feedback to clients and identification of stages of change (Eckhardt et  al., 2004), either as a core part of treatment (e.g., Kraanen et  al., 2013; Murphy et  al., 2018) or as a precursor to treatment (e.g., Chermack et  al., 2019). Findings indicated that interventions that incorporated motivational strategies improved intervention dose and reduced dropout compared to interventions without motivational strategies. However, no differences were found in subsequent perpetration between interventions with and without motivational strategies, though trends in effect sizes favored interventions with motivational strategies over those without, and the number of studies was very low, raising issues around statistical power to detect differences. Another focal point has been to tailor treatment based on emotion dysregulation possibly related to mental health issues (e.g., trauma). One early study by Saunders (1996) that supported the notion of tailored treatments found that men with dependent-­ type personality traits responded more favorably to psychodynamic treatment versus cognitive-behavioral treatment, but men with antisocial traits did not show this differential effectiveness. More recent studies have examined acceptance and commitment therapy (ACT) for aggression and partner violence. Findings from a small randomized trial with partner aggressive individuals found reductions in aggressive behavior favoring ACT over control, and those reductions were due to the hypothesized mediating processes of experiential avoidance and emotional skill

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deficits (Zarling et al., 2015). A much larger community-based evaluation compared outcomes for over 3400 men who received either the ACT model or a typical group-­ based Duluth/CBT treatment model and found those receiving ACT were less likely to have been arrested for domestic violence or for any violence in the subsequent year after treatment (Zarling et al., 2019) compared to those receiving the Duluth/ CBT based model.

Dyadic Approaches to Addressing IPV Dyadic approaches to addressing IPV have been highly controversial (Jory et al., 1997). The controversy stems from at least three areas: (1) involving the nonaggressive partner can be construed as victims blaming as it may indicate they are part of the dynamic leading to violence; (2) victims in violent relationships cannot freely participate because of being controlled by the partner and maybe fearful of retaliation; and (3) the concern that dyadic-based treatments can cause violence to escalate because of retaliation. Acceptance of dyad-based treatments has grown over time, however (O’Leary, 2002; Stith et  al., 2004; Whitaker et  al., 2006a), driven by a number of factors including (1) poor performance of individual perpetrator-focused interventions (Babcock, Costa, et  al., 2004a); (2) research showing that bidirectional perpetration is not uncommon (Archer, 2000, 2002) and that IPV is often driven by emotional expression, retaliation, and relationship conflict (Langhinrichsen-­Rohling et al., 2012); and (3) a recognition that separation or a dissolution of the relationship is often not the goal of couples who use IPV (Jose & O’Leary, 2009). Couple-based treatments have shown positive impacts in addressing poor communication, conflict resolution, and relationship dissatisfaction (Byrne et al., 2004; Rathgeber et al., 2019), and thus they may be useful for curtailing conflict-based IPV. Indeed, an early study by Markman and colleagues (Markman et  al., 1993) that tested a premarital relationship education program (PREP) for reducing relationship discord found that the PREP program improved communication, reduced conflict, and reduced IPV after 5 years, though the program did not target violence specifically. Data on the effectiveness of dyadic-based interventions are beginning to emerge. A review by Karakurt and colleagues (Karakurt et al., 2016) included six high quality studies testing dyadic-based interventions designed to reduce IPV in couples who were already using violence. Overall, a medium-sized effect was found favoring the dyadic-based interventions over control, with relatively little heterogeneity between studies. Karakurt et al. (2016) suggested there is “moderate” strength of evidence supporting dyadic-based interventions based on GRADE standards, a system used to judge the strength of evidence for a particular intervention (Atkins et al., 2004) because of the consistency of the results, the quality of the studies, and the clinical relevance of the outcomes. Only the relatively limited number of studies prevented a rating of strength of “High.”

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One particularly promising program reviewed by Karakurt et al. (2016) is the Creating Healthy Relationships Program (CHRP; Bradley et  al., 2011) designed specifically for situational or common couple violence, which is typically low level, bidirectional, and prompted by conflict (Johnson, 1995). The is a 22-week group program for couples based on Gottman’s work on communication and affective patterns in functional and dysfunctional couples (Gottman, 2014). Each session covers a different topic, for example, preventing fighting, expressing needs, compromising, avoiding violence, stress reduction, anger, and staying close. The program is facilitated jointly by a female and a male clinician, who check in periodically with each couple to ensure violence is not injurious or controlling. Data on CHRP are promising with studies showing improvements in reductions in violence (Cleary Bradley & Gottman, 2012) and behaviors that may lead to violence (Bradley et al., 2014). Interestingly, there is supporting evidence that dyadic-based interventions addressing substance use can be effective in reducing IPV, even if not addressing violence directly (Murphy & Ting, 2010). Substance use is related to both IPV victimization and perpetration (Cafferky et al., 2018), and to the extent there is a causal relationship, reduced substance use should reduce IPV. Two experimental studies by Fals-Stewart and colleagues (Fals-Stewart & Clinton-Sherrod, 2009; Fals-Stewart et al., 2002) that tested behavioral couples counseling to address male substance use found reductions in male-to-female IPV following treatment when compared to individually based therapy. Other, nonexperimental studies have found reductions in IPV following treatment for substance use (Murphy & Ting, 2010). Gilchrist’s narrative review (Gilchrist et al., 2019) identified several ways in which substance use may impact violence including intoxication, issues related to withdrawal, and via its impact on the relationship. The relationship between substance use and IPV has led some to recommend that policies restricting alcohol outlet density may impact IPV rates (Niolon et al., 2017), though reviews suggest a more complex picture (Gmel et al., 2016). Stith and colleagues (Stith et  al., 2005) offered recommendations for dyadic-­ based treatments for partner violence include several safeguards: (1) each member of the couple must voluntarily choose to participate when interviewed separately; (2) there has been no severe, dangerous violence, or violence outside of the home (to friends, strangers); and (3) both partners are willing to sign a “no violence” contract. Stith et  al. (2005) also recommend that couples complete gender-specific treatment groups prior to conjoint treatment that focuses on a range of topics for individuals involved in mild to moderate violence. Those topics include review of partner violence, types of abuse, the use of violence for control, escalation signals, alcohol/drug use and violence, and conflict resolution skills.

Recommendation for Clinicians Regarding IPV Based on the research reviewed in the preceding sections. We make the following recommendations for clinicians to address IPV.

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• Assessment is critical when working with individuals who may report partner violence. It is important to assess the frequency, severity, and dangerousness of partner violence before committing to a particular treatment type. A number of assessment tools can be used to determine danger (Campbell et al., 2000) and to assess different types of violence (Friend et al., 2011). • Overall evidence for community-based group interventions targeting individual IPV perpetrators is not strong; they do not appear to have much impact. • Understanding and addressing motivation for treatment is critical. Individuals who are not motivated to be in treatment will likely not benefit. • Dyadic-based interventions for couples with nonsevere violence appear more promising, but ensuring safety is paramount when working with dyads. Understanding affect dysregulation, substance use, and couple dynamics may help the clinician understand proximal determinants of violence, whether they are working with an individual or a couple.

3 Chapter Summary There are promising interventions to address both child maltreatment and IPV. Parent-focused interventions are a mainstay in both prevention and intervention settings for child maltreatment. Programs such as SafeCare, Triple P, and PCIT are effective, brief, and dissemination ready; they can readily be adopted by service systems or individual providers. Attachment-based programs are growing in popularity, particular for parents with trauma histories that may interfere with bonding. When choosing a particular program, one should be mindful of client characteristics (e.g., trauma history), as well as issues around service capacity and efficiency. Short-term models such as SafeCare and PCIT have been shown to be both effective and highly cost-effective. For example, estimates suggest that SafeCare and PCIT return over $20 and $15, respectively, in benefit for every dollar spent on implementing those programs (Washington State Institute of Public Policy, 2020). Longer programs such as CPP and NFP may have to be weighed more carefully as they require greater resources, though it is important to note that those programs also provide considerable benefit relative to cost, CPP ~ $14 per dollar spent; NFP = $1.37 per dollar spent (Washington State Institute of Public Policy, 2020). Clearly, there is much to learn about program effectiveness for addressing family violence. For both child maltreatment and IPV interventions, there are basic questions regarding program effectiveness to be addressed. Moreover, questions regarding “what works for whom” are gaining prominence in the literature, particularly in the area of prevention science. The concept of “precision prevention” (Ridenour, 2019; Supplee & Duggan, 2019), borrowed from a precision medicine frameworks, seeks to understand how to optimize interventions based on the individual characteristics under the assumption that particular interventions will work under certain circumstances or for certain individuals. In the area of IPV, the focus on understanding motivation for treatment, or how a trauma history may push an individual to

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respond to particular interventions is a move in this direction. Another critical and related area regarding intervention effectiveness is the applicability of interventions for underserved communities and people of color to reduce disparities. Most interventions have been developed and tested with the majority populations, and the relevance of those interventions for nonmajority populations must be carefully considered. Behavioral parenting interventions have been shown to be robust across populations (Chaffin, Bard, et al., 2012a) and have been implemented in developed and low- and middle-income countries representing a range of cultures. Triple P, for example, has been implemented in 30 different countries on 6 continents around the world (see Triplep.net). Last, though this chapter has focused on behavioral interventions, family violence can be heavily influenced by social policy not requiring intervention. For example, data suggest that the implementation of economic support programs that reduce poverty results in reduced cases of maltreatment (Puls et al., 2021). In Africa, micro finance programs to promote economic self-­sufficiency among women have been shown to reduce episodes of IPV (Pronyk et al., 2006). Thus, behavioral intervention is an important tool for addressing family violence, but it is not the only tool. The pairing of behavioral interventions with economic support policies may be an especially potent means for addressing family violence.

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Whitaker, D. J., Baker, C., & Arias, I. (2006a). A review of relational strategies for the prevention of intimate partner violence. The Family Psychologist, 22. Whitaker, D. J., Morrison, S., Lindquist, C., Hawkins, S. R., O’Neil, J. A., Nesius, A. M., Mathew, A., & Reese, L. (2006b). A critical review of interventions for the primary prevention of perpetration of partner violence. Aggression and Violent Behavior, 11(2), 151–166. Whitaker, D. J., Haileyesus, T., Swahn, M., & Saltzman, L. S. (2007). Differences in frequency of violence and reported injury between relationships with reciprocal and nonreciprocal intimate partner violence. American Journal of Public Health, 97(5), 941–947. Whitaker, D.  J., Hall, D.  M., & Coker, A.  L. (2009). Primary prevention of intimate partner violence: Toward a developmental, social-ecological model. In C. Mitchell & D. Anglin (Eds.), Intimate partner violence: A health based perspective (pp. 289–305). Oxford Press. Whitaker, D. J., Murphy, C. M., Eckhardt, C. I., Hodges, A. E., & Cowart, M. (2013). Effectiveness of primary prevention efforts of intimate partner violence. Partner Abuse, 4(2), 1–28. Whitaker, D. J., Self-Brown, S., Hayat, M., Osborne, M., Weeks, E., Reidy, D., & Lyons, M. (2020). Effect of the SafeCare© intervention on parenting outcomes among parents in child welfare systems: A cluster randomized trial. Preventive Medicine, 138, 106167. Wilson, D.  B., Feder, L., & Olaghere, A. (2021). Court-mandated interventions for individuals convicted of domestic violence: An updated Campbell systematic review. Campbell Systematic Reviews, 17(1), e1151. https://doi.org/10.1002/cl2.1151 Yakeley, J. (2022). Treatment for perpetrators of intimate partner violence: What is the evidence? Journal of Clinical Psychology, 78(1), 5–14. https://doi.org/10.1002/jclp.23287 Zarling, A., Lawrence, E., & Marchman, J. (2015). A randomized controlled trial of acceptance and commitment therapy for aggressive behavior. Journal of Consulting and Clinical Psychology, 83(1), 199–212. https://doi.org/10.1037/a0037946 Zarling, A., Bannon, S., & Berta, M. (2019). Evaluation of acceptance and commitment therapy for domestic violence offenders. Psychology of Violence, 9(3), 257–266. https://doi.org/10.1037/ vio0000097 Zielinski, D. S., Eckenrode, J., & Olds, D. L. (2009). Nurse home visitation and the prevention of child maltreatment: Impact on the timing of official reports. Development and Psychopathology, 21(02), 441–453.

Chapter 10

Police and Court Interventions for Family Violence: Evidence-Based Practices Darren Walton and Ross Hendy

When asked to consider what happens when two instructions are in contradiction, the philosopher Ludwig Wittgenstein offered that the effect is incapacitation, but he added, that may even be its purpose (Wittgenstein & Bosanquet, 1989, pp. 174–176). You can no more go left and right at the same time than you can both arrest and warn, assess as high and low risk or punish and advise. In the policing of family violence, knowing what to do is marred by research evidence showing the same factors that increase the likelihood of revictimisation also decrease the likelihood that a victim-survivor will participate. So, for example, whether the aggressor is intoxicated is more likely to lead to revictimisation (Jones & Gondolf, 2001; Hirschel et al., 2010) and decrease the likelihood that a victim-­ survivor will make a call to police or support a statement (Rhodes et  al., 2011; Robinson & Cook, 2006; Felson et al., 2005). The same is likely true for whether a victim has had previous contact for family violence leading to the arrest or threatened subsequent arrest of the perpetrator (Felson et al., 2005; Weisz, 2001). In such a circumstance, actual policing becomes paralysed (Segrave et al., 2018). The events that require more action have less likelihood of coming to attention or progressing because of action. In this chapter we use the expression family violence only if it applies to a specifically defined research outcome. Similarly, we refer to victim-survivors for the set of persons who are directly affected by family harm, and victims only as it might apply to specific research outputs. We will avoid the term domestic violence completely, except as it applies historically. D. Walton (*) University of Canterbury, Christchurch, New Zealand New Zealand Police, Wellington, New Zealand e-mail: [email protected] R. Hendy Monash University, Clayton, VIC, Australia © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 P. Sturmey (ed.), Violence in Families, Advances in Preventing and Treating Violence and Aggression, https://doi.org/10.1007/978-3-031-31549-7_10

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In the research literature the practical contradiction manifests itself in now famous methodological and evidential muddles. Consequently, we can find that an intervention might work for some, such as people who are employed (Schmidt & Sherman, 1993), males (Cho & Wilke, 2010) or batterer subtypes (Johnson & Goodlin-Fahncke, 2015) but not for all. Well-intentioned interventions may on balance be found to do more harm than good (Sherman & Harris, 2015; Schmidt & Sherman, 1993). Reviews of ‘what works’ have concerns for the quality of research designs (Garner & Maxwell, 2008), the rigour of methods (Ariel & Sherman, 2012), the movement of definitions of dependent variables (Sweeten, 2012), the identification and correct classification of offenders (Boxall et al., 2015) and the scope and size of samples used to support general positions. Perhaps most concerning, there is the lack of theory specific to addressing issues of family harm prompting a call to ‘think meta-analytically’ recognising that assembly of the evidence requires systematic review (Sugarman & Boney-McCoy, 2000). Others have cautioned against any simple use of meta-analysis (Berlin & Golub, 2014; Strube & Hartmann, 1982). This chapter offers to navigate through this confused position. We do not offer a single solution to the policing of family harm; we present the latest practices applied and evaluated in New Zealand. There is good evidence of variation among countries. So, for example, the rates of help seeking are significantly higher in Canada (Barrett et al., 2020) than New Zealand (Malihi et al., 2021). Adopting a pragmatic approach, this chapter offers a simple framework which practitioners from elsewhere might find helpful when assessing their own interventions. The methods used in large-scale evaluations, and the adoption of a Big Data paradigm (Kitchin, 2014), are highlighted to underscore how New Zealand Police knows that its interventions work, these Big Data methods being no less important than the identification of the factors related to successful practice. The complexity of this area is compounded by the lack of any consistent definition for the concept of family violence. In practice it reflects the routine duties of frontline police, and perhaps as much as approximately 40% of their activities (New Zealand Family Violence Clearinghouse, 2017). Within the New Zealand criminal justice system domestic violence and less often family violence are referred to as family harm. Family harm is usefully characterised as, ‘…a disruption to the fabric of family and whānau structures and has an impact on victims’ long-term mental health (such as post-traumatic stress disorder, anxiety related disorders, depression, substance abuse and increased risk of suicidality), spiritual wellbeing, attachment to others and parenting capabilities’ (Family Violence Death Review Committee 2014, p. 18). Whānau is the Māori word for family, but it carries a wider definition than traditional European concepts. Whānau is formally an extended family or community of related families who live together in the same area. In certain uses whānau may refer to a political unit. In everyday use the word whānau is adopted by users in New Zealand to mean a group bonded together. For example, it is not uncommon for members of police to refer to the police whānau. So, the term family harm is used to broaden consideration to include psychological harms consequent to an explicit act of violence within families and whānau. Other expressions, particularly domestic violence, reinforce a stereotyped set of

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encounters, and unnecessarily focus on the gendered construct of males physically assaulting females. In doing so, there is a particular tendency to overlook harm to children, and harm to children as witnesses of events. (For early reviews see Dyregrov, 2004; Edleson, 1999; Margolin et al., 2010; Wolfe et al., 2003). New Zealand has recently introduced a suite of legislative changes. The Family Violence Act 2018 definition of ‘family violence’ encapsulates this broader array of harms within the confines of a family unit including intimate partner violence, child neglect and abuse. Changes to the Crimes Act 1961 included the introduction of a new classification of ‘assault on a person in a family relationship’ to acknowledge the diversity of dyadic types that constitute a family and replacing all past offences such as ‘male assaults female’. For frontline officers family harm represents over 300 offence types and occurs between more than 30 dyadic relationship types (Bland & Ariel, 2015; Walton & Brooks, 2019). Note that offence codes do not neatly overlap with offences but in Australasia are defined broadly by the Australian Bureau of Statistics into Australia New Zealand Standard Offence Codes with the intent of supporting cross-­jurisdictional analysis of police performance. Thus, by this definition, family harm has around 9000 divisions of offence types and dyads. This breadth creates a challenge for researchers, what has been described as the ‘reach of the term’ (Kelly, 2005). Family harm is not easily conceptualised because it is an entire class of behaviours that is vast in size and variation. Importantly, family harm is not defined by any list of offence types, nor relationship types, but by a combination of the two. The scope of family harm spans the neglect of children to murder; it occurs between intimate partners, adolescents who harm parents (Moulds et  al., 2019), ex-partners, current partners, same-sex couples (Chan, 2005), grandparents, siblings and other types of complex social dependencies. New Zealand’s term family harm is a deliberate turn in the opposite direction of researchers attempting to address the scale of the problem by reducing it to its component parts. Kelly (2005) argued the problem of reach was resolved through the introduction of the term ‘Intimate partner violence’ (IPV). That is, if researchers and others restrict attention to IPV there is a capacity to assess the scale of the problem. It is a common strategy of researchers to limit inquiry to subsets of family harm such as IPV (e.g. Dowling, 2018) but this creates boundary conditions (Sugarman & Boney-McCoy, 2000) that limit the practicality of advice. Nagel (1961) argued that such restrictions in the probabilistic range of social research make the result either trivial (e.g. advocacy for improved officer training) or unimportant, as the knowledge derived from research is so specific to circumstances it becomes impossible to implement, undermined by the many restrictions used to derive it.

1 The Legacy of Sherman and Berk (1984) The famous Minneapolis Domestic Violence Experiment (Sherman & Berk, 1984) has been re-examined by others through the lens of understanding pro-arrest/mandatory arrest polices (Felson et al., 2005), concerns for replication (Fagan, 1996) the

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problems of integrating results from different studies (Exum et al., 2014) and the prioritising of police action over victim agency (Stanko, 1995). It is now somewhat accepted that mandatory arrest is not statistically related to reductions in re-­ offending (see recently Garner et al., 2021; Xie & Parkany, 2019). So, in assembling a list of effective police and court interventions, the first that might be added to the ineffective list is pro-arrest/mandatory practices. The history of this policy, its support and controversy have special relevance to police trying to develop practices to prevent family harm. There are three additional observations to make about the journey of evidence supporting this current view. First, the adoption of the pro-arrest/mandatory arrest intervention once resolved an evidential paradox by removing the victim-survivor’s agency – by constructing policy that required an arrest irrespective of whether it was what the victim wanted or was, from the victim’s perspective, in the victim’s interest (Garner et al., 2021; Hoyle & Sanders, 2000; Stanko, 1995). Second, researchers argued the victim can be especially irrational, impaired in their capacity to make sensible decisions or in some other way especially vulnerable (Hanna, 1996; Walker, 1979). This position is controversial (Cornia, 1997) but a pro-arrest/mandatory arrest policy usually acknowledges it (Boivin & Leclerc, 2016). For completeness, the alternatives are: (1) that the failure is in the police action, that what police provide is not what the victim wants; and (2) that police attendance is all the victim wanted. Each of these options re-conceptualises the victim as perfectly rational and, thus, Wittgenstein’s observation that a contradiction can have purpose – it simply stops events. Third, the pro-arrest/mandatory arrest intervention focuses on the outcome of the police action made against an offender, often ignoring the broader impact of the same intervention on victims, and victims’ willingness to participate in seeking support from police. The Minneapolis experiment was originally targeted towards a theoretical dilemma of whether punishment changes behaviour, with arrest being construed as a punishment. Alternative actions within the police discretion such as warnings, informal mediation, advice and the temporary removal of the aggressor were seen as less invasive to the family. However, these alternatives were commonly used in response to other street-offences at the time (Black & Black, 1980; Muir, 1979). Sherman and Berk (1984) were not focussed on family harm -- especially not as it is defined above. It was for them just a ‘particular setting, for a particular offense, and for particular kinds of individuals’ (p. 262) to test the effectiveness of deterrence theory (Garner et al., 2021). However, with a modest sample (N = 330) and after 6 months of follow-up, using both administrative data and a predetermined set of questions within for follow-up interviews with victims, they found there was an 18.2% recidivism rate (broadly defined to mean those within the sample who came back within police attention for family harm). Those arrested had a 13% rate of recidivism, those separated 26%, the group offered advice was reported as no different, ‘indistinguishable from the other two’ (p.  267). This outcome is technically impossible. If A is statistically different from B then C can only be indistinguishable from A or B but not both. It appears from the original study that the advice condition was not significantly different from the group offered separation. This still leave

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arrest as significantly different from these other practices. Using three related approaches to the analyses and corroborating the result by a follow-up self-reported data set based on surveys with the victims, Sherman and Berk (1984) laid the evidential foundation for pro-arrest/mandatory arrest policies. The impact of the Minneapolis Domestic Violence Experiment was reported as ‘striking’ (Felson et al., 2005), ‘most influential, seminal’ (Garner et al., 2021) and ‘widely accepted’ (Sherman, 1992). Sherman acknowledged that the work was swept up within an advocacy for change to police practice. Indeed, it had an immediate and widespread impact with 84% of US urban police agencies adopted a pro-­ arrest policy within 2 years of the study (Sherman, 1992). By 1987 the New Zealand Police Commissioner amended standing orders to require officers to make an arrest in ‘all domestic cases where evidence of assault or breach of an [order] existed unless the assault was extremely minor or there were strong extenuating circumstances’ (Newbold & Cross, 2008, p. 5). The American National Institute of Justice sponsored six replications of the Minneapolis Domestic Violence Experiment, five were completed (Berk et  al., 1992; Maxwell et  al., 2002; Pate & Hamilton, 1992; Sherman et  al., 1992a, b). Together these studies constitute what is known as the Spousal Assault Replication Programme (SARP). Two new studies supported the original findings (Berk et al., 1992; Pate & Hamilton, 1992), and three others found no effect, or increased recidivism. Collectively the authors introduce the term escalation to mean that arrest may indeed increase the likelihood of reoffending, and specifically for unemployed African American offenders. The outcome is now well represented to have produced mixed results (Sherman, 1992). While the SARP experiments were designed to further test the deterrence effect of arrest, each individual experiment differed from the research design of the original experiment to the point beyond which they could be considered true replications (Sherman, 1992). To improve the reliability of treatment selection, the SARP experiments specified a treatment only after a case had been assessed by field officers as being eligible for inclusion in the experiment. This was an attempt to prevent field officers from gaming the experiment. But each experiment had different treatments that were tested. The Metro-Dade experiment had three conditions: (1) arrest, (2) arrest with follow-up counselling at police station and (3) no-arrest or counselling. The Charlotte experiment had two conditions: (1) arrest or (2) summons from home without removal. The Milwaukee experiment compared (1) arrest plus 3 hours of custodial detention with (2) arrest plus 12 hours of custodial detention. In constructing replications, each SARP experiment tested different treatment outcomes, and blurred the actual deterrent mechanism being tested (i.e. arrest, post-­ arrest detention, prosecution and/or conviction). Participant eligibility also varied among SARP experiments. For instance, the Metro-Dade experiment had no power for warrantless arrest for unmarried couples in that jurisdiction which resulted in a higher proportion of married couples in their sample, whereas the Charlotte experiment excluded cases that featured male victims. Moreover, the offence eligibility differed: while some experiments limited offence types to misdemeanour assaults, Colorado included incidents including criminal harassment situations without physical assault.

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More recent efforts have used samples from large national surveys. Felson et al. (2005) used a longitudinal design following the US National Crime Victimisation Survey for a 10-year period (1992–2002). They tracked offender recidivism for 2564 respondents who were each interviewed six times over 3 years. Their analysis revealed that reporting an assault has a stronger effect to reduce recidivism (i.e. repeated IPV offences) than if an arrest was made. More recently, Xie and Lynch (2016) followed a similar approach. They used same survey to show that the likelihood of repeat victimisation was not related to arrest but was related to the reporting of crime to the police. They went an additional step and developed a propensity score case/control design to reduce bias by between groups who either were arrested or not. After controlling for these baseline differences, the estimated effect of arrest was, on average, near zero. Garner et  al.’s (2021) meta-analysis of 57 studies identified five significant factors influencing whether pro-arrest of intimate partner violence leads to a positive effect in reducing future harm: (1) The source of the data used; (2) the definition of recidivism; (3) whether the recidivism was violent; (4) whether the victim was the same person; and (5) an assessment of the rigour of the study. However, these conclusions applied to results that varied across the effects for prosecution, conviction and incarceration, which are all quite different outcomes of engagement with the criminal justice system, the last being a relatively rare outcome which Sherman and Berk (1984) acknowledged, measured and excluded in the original study. Garner et al. (2021) conclude that recidivism increased when it was measured using victim interviews and not when using administrative police data. If new offences were included, then recidivism decreased. However, if arrest was used as the criterion, then there was a significant escalation effect. (Garner et al., 2021 did not define escalation except to suggest that it meant to increase rather than diminish the likelihood of reoffending. It did not mean here that the offending increases in severity of harm as might be measured using modern indices of harm; Dudfield et al., 2017). If the studies are focused on ‘just violent offending, then there is no significant relationship between arrest and the likelihood of reoffending’. The situation is complicated by results finding a strong deterrent effect applies when the studies use ‘new offenses against the same victim—not new arrests or new convictions against any victim—as the criteria for repeat offending’ (p. 228). Apart from Fagan (1996), what is usually overlooked in examining the details of the relationship between pro-arrest policies, and this history of research, is that the initial research was not actually seeking to improve police action. Sherman and Berk did not test a hypothesis on what might work to reduce family harm, nor did they evaluate a program-wide change in police practice. They have received criticism on this position because the conclusion, drawn by others motivated to change policy, extended beyond the data. Sherman and Berk never tested whether recidivism reduced when compared to no action at all (Hirschel & Hutchison, 1996). Despite the importance of research, the study offered no obvious improvement to the option to arrest (Weisz, 2001).

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2 A Modern Approach: The Development of Evaluations to Support Understanding What Works Savage and Burrows (2007) predicted that the impending inundation of administrative data would challenge the legitimacy of social scientists claim to knowledge, pointing to what they called ‘transactional data’, the data held by large companies and Government agencies. By 2014 they reflected on the new description of a new term, Big Data, the role of the data scientist and the ‘possibility of describing the social world in a manner hitherto impossible’ (p.  69). They now predict that the new capability is unlikely to unite but rather polarise those seeking to claim legitimacy in fields of social inquiry. The arrival of Big Data converges with the uptake of police science to support what works in the policing of family harm. New Zealand uses evaluations, taking a big data approach to evaluate a family harm intervention, a journey that has some parallels with the experience of Sherman and his colleagues, at least as it unfolds in a dynamic interplay between the results of research, and its influence on practice. New Zealand Police (NZP) is a national police agency, with over 14,000 staff under centralised leadership, and a single national dataset of all contacts with police that are linked to the outcomes of the criminal justice system (Hendy, 2021). New Zealand adopts a new model of police intervention within a recent national strategy, Te Aorerekura, that embraces a third-party policing approach in concert with its Prevention-First strategy (NZ Police, 2017), and the implementation of evidence-­ based policing (Sherman, 1998, 2013). In 2022 the Government appointed a minister for the prevention of family violence and sexual violence, following the updated legislation. These developments coincided with a past recognition that New Zealand was considered the worst in the OECD for family harm (This has always been in error, despite numerous news reports citing such. NZ ranks fifth worse in the OECD). New Zealand has lifetime prevalence of family harm of around 30–33% (Fanslow & Robinson, 2004). The response capability of NZP is augmented with smartphone technology for receiving real-time updated information on offender risk and assessment information for family harm (Jolliffe Simpson et al., 2021) and a bespoke application for investigating and documenting family harm investigations at the scene. Structured questions are answered for all family harm events including identifying whether alcohol or mental health are factors. All reports are reviewed by a file management centre where specialist staff flag any record that fall within the definition of a family harm event. Note that this is not yet achieved by an algorithm, largely through the influence of the complexity and the 9000 division of relationship and offence types. The uptake of technology has facilitated the development of digital recording of family harm victim statements (Walton et al., 2021). Crucially, NZP developed, and integrated into its data systems, the NZ Crime Harm Index (NZCHI) (Curtis-Ham & Walton, 2017). A crime harm index offers a new way to measure offending, event severity and outcomes; it can reveal outcomes that counting crimes would obfuscate

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(Walton et al., 2019) and is a key requirement of evidence-based policing (Sherman et al., 2016). New Zealand’s national statistics demonstrate that Māori are significantly over-­ represented in the New Zealand criminal justice system as both offenders and victims. Māori make up 16.1% of the national population but 42% of all police apprehensions and 51% of the male prison population, and higher for females (61%) (Department of Corrections, 2016). Māori are twice as likely to be an offender of a serious crime against a family member. Similarly, as victims, Māori are more likely to be the victim of a crime (33% vs 24% for non-Māori) and are more than twice as likely to be victim of family harm (11% vs 5% for non-Māori) (Ministry of Justice, 2014). With this context it should be unsurprising that New Zealand was determined to establish a new approach to family harm, one appropriate to Māori, one that adopted a te ao Māori worldview. The programme developed in consultation, and largely without the direct link to research to support the design. It is best considered as a whānau-centred, early intervention programme.

3 Whāngaia Ngā Pā Harakeke The flagship response to family harm is a police and community-based partnership model, called Whāngaia Ngā Pā Harakeke (WNPH) (pronounced Far-Nigh-A, Nah, Pa, Hara, Key-Key). The programme represents partnerships between NZP, local iwi organisations, community social service providers and other government departments. (Iwi represent the broadest grouping of Māori, similar to the concept of tribe, linked to locations throughout New Zealand. All Māori should be linked to one or more iwi but it is recognised that affiliation to the group may be dislocated by geography, history and all forms of social disadvantage). WNPH directs resourcing towards reducing the incidence of family harm in New Zealand communities and co-ordinates a multi-agency response that prevents ineffective multiple approaches to the same need. WNPH intention is to address the problems of family harm at the flax roots. The translation of Whāngaia Ngā Pā Harakeke is ‘to give support at the flax roots’. Thus, the name Whāngaia Ngā Pā Harakeke is a play of the English expression ‘grass roots’, as the foundation or source. It weaves together the efforts of multiple partners to achieve a stronger whole than the individual strands and attempts to get ahead of the problem by addressing the cause of the harm, being responsive to victim, aggressor, and wider family need. The usual implementation of WNPH requires that all police-attended family harm investigations or any event referred from an outside agency to be considered through a separate review by an inter-agency panel. A panel of cross-agency representatives meets daily to consider the police-attended family harm events in the previous 24 hours. The panel has access to the data systems of health, social services, justice and police records for all persons. It considers all the current circumstances of all persons involved, their histories with police, health, justice (e.g.

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imprisonment or probation services) and any other relevant information. The panel also considers the ongoing impacts on children as witnesses. The role of the panels is to review the likelihood of re-offending, vulnerabilities of persons involved in the event, likely stressors on the family (Pattavina et  al., 2015), and the outcomes and levels of engagement of any previous recommendations made and referral or support provided. The panel may make a referral to community-­based agencies for an appropriate follow-up with the parties to the episode, to offer support and assistance. That support may be directed towards the offender, the victim or to whānau. Police can also receive a referral, to staff who deal with family harm or those specialists who deal with high and complex risk such as sexual assaults or extreme risk. Follow-ups might be as simple as phone calls to the aggressor offering support services, or more involved such as referral to alcohol and drug treatment. The preference is to deliver a face-to-face meeting, sometimes facilitated by specialist social workers, known as Kaiāwhina. The most distinguishable feature of WNPH, that sets it apart from other programs, is that the intervention is not dependent on the detection of a criminal offence. The call for police attendance will generate the multi-agency review that considers the circumstances leading up to police attendance. No charge needs to be laid or offence identified for a referral to be made. Support is not dependent on the perceived risk or seriousness of the event, though a main function of the panel is to triage an appropriate response. Importantly, the documentation of each case reviews records relevant situational details, such as the stressors acting to cause the event, and follow-up planning. The database of records is assessable by partner agencies.

The Evaluations of Whāngaia Ngā Pā Harakeke New Zealand’s shift into model of police partnerships with community started with a trial in one of the 12 districts that make up the entire jurisdiction. NZP were willing to experiment and in effect introduced a field-trial of over a half million people, over 2–4 years to provide evidence of program effectiveness. Descriptive statistics identified that Counties-Manukau represented the one of the most deprived areas of South Auckland, which also had the greatest need for a new approach to Policing Family Harm. From 2016, all police attended events (over 20,000 police per annum) who were divided into either a WNPH-reviewed event or proceeded as business as usual depending on an approximately even division of the district. Note this is not a random assignment as the division was based of the geography of the Police District. The events were flagged under new code designations (one was especially introduced for the new practice to be identified as WNPH in the administrative data) and left to run for 18 months before being implemented throughout the entire district. The evaluation that followed (Walton & Brooks, 2019) uses an interrupted time series design (Bernal et  al., 2019). The NZCHI was employed to determine that WNPH reduces the NZCHI-values of the harm from offending (i.e. not detectable as a count of offences) of those offenders who are part of the intervention,

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particularly those who are not first charged with any offence. The overall impact was seen not in high-volume recidivist offenders but in the reduction in the expected level of harm in subsequent offending assessed by baseline in the low volume, infrequently seen group. This was because around two-thirds of police-attended events for family harm occurred in situations and circumstance in which no offence is identified. The calculated benefit of the programme was a 15% reduction in the crime harm associated with offences. The evaluation challenged common preconceptions that included a belief that family harm occurred in a series of events escalating in severity (agreeing with Bland & Ariel, 2015); re-occurred without the benefits of outside support in short cycles of months (see also Felson et al., 2005), or weeks; and is characterised as violence against the individual as opposed to other forms of coercion and control, especially property damage. For example, 72.5% of the charges laid were for violent offences but these represented just under 40% of the overall calculated harm. The second-­most frequent charge in family harm was for wilful damage such as smartphones being thrown or smashed.

Subsequent Trials and Evaluations Regions throughout New Zealand differ in population demographics, resourcing and in the distribution of the incidence of the common stressors that contribute to family harm (e.g. unemployment and other forms of social deprivation, including the prevalence of addiction, alcohol consumption and so on). No two police districts are exactly alike and so programmes of intervention are tailored to localities. The developments and design of these programs are often community-led. One example is the Gandhi Nivas initiative, a community shared house in which perpetrators are taken, voluntarily, by police (Morgan et  al., 2020). Other districts use specialist community workers for follow-ups after family harm events (Love et  al., 2019), especially in areas with an over-representation of family harm involving Māori. The second evaluation of WNPH was in Tairawhiti, in the Eastern Police District (Walton & Brooks, 2020). The willingness to manage an experimental design was not acceptable to frontline police. (Sherman and Berk discuss the same problem in the original study). Support for further experimentation evaporated with the findings from the first evaluation. District staff had learned of the success of the programme and were eager to implement it, notwithstanding the very significant demographic differences between the first trial location. The second evaluation adopted a design to account for a shorter implementation, and that the district elected not to evenly divide areas of service but held off a wide implementation for 12 months. The methodological challenge of evaluating this site was met using a propensity-matched case-control design (King & Nielsen, 2019), drawing 823 cases for the treatment group from all events attended in a 100-day period, around 6 months after the WNPH had started. A control group was matched on characteristics of the event, participants’ prior convictions, time of the event and

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event severity. The method of analysis followed all parties for a further 6–9 months and considers all subsequent offending (Walton & Brooks, 2020). It was seen as an advantage that the samples were drawn quite some time after the initial implementation of WNPH, but this really coincided with a centralised system for recording events that provided the best insight into who was progressing through WNPH. This second evaluation found an estimated 18.7% reduction in the crime harm associated with the treatment compared to the matched control. Most important, again the effect was not derived from the impact on recidivist offenders (those who entered the treatment being charged with an offence within a three-month point prevalence). Rather, the main impact of WNPH was for all those who sought service (offenders and victims) through a call to police. This group had significantly lower harm if they did offend later compared to their matched controls. There have been three further evaluations of the programme, each focused at a police district level (Auckland Central, Southern and Waitematā). The Waitematā study is being completed and the work is forthcoming. Each of these evaluations adapts to the circumstances of a programme being progressively rolled out, based on the experience of previous districts, the learnings that accompany implementation, and previous evaluations. Where the first two districts deliberately divided their areas to allow for evaluation, the new districts adopting WNPH refused to allow a perceived and evidentially supported improvement to be withheld. It is a recognised ethical dilemma (Polaschek, 2016). Consequently, the recent evaluations rely on the natural experiment that arises from monitoring those who offend and compare these to those that offend after they have been seen and referred to WNPH.  Rather than becoming increasingly methodologically robust (Farrington et al., 2002), the impact of the evaluations forced new research to consider increasingly more data-intensive strategies and quasi-experimental, observational designs. The summary of the findings from the multi-year data science led evaluations is shown in Table 10.1. It is not necessary to agree with the findings of the programme evaluations to recognise that they offer a radically different approach to determining what works. They offer what Kitchin (2014) recognised in the advent of Big Data analysis (a straight to practice uptake), with the roll-out of WNPH now supported by centralised funding. Kitchin’s conception of a fourth paradigm contrasts with Sherman’s description of evidence-based policing. The evaluations are closer to commercial practice that absorbs business intelligence and market research at a pace experimental research cannot achieve. Indeed, a review of the evidence might not have supported the community partnerships approach (e.g. Garner & Maxwell, 2008). Although Garner and Maxwell called for critical appraisal of the evaluations, their review of the community partnership models found the state of the evidence at the time to be, at best, inconclusive. The important idea, for now, is that these forms of evaluation measure a change in practice across the whole range of things we call family harm (without restriction to say, IPV) and can do so relying on the modern development of data science, including methods of data reduction inherent in a crime harm index. It might also be observed that rarely does an intervention operate in isolation but generally comes packaged within a suite of changes, and that the big data science paradigm is

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Table 10.1  Summary of the findings of evaluations across other districts in New Zealand

History

Record of safety assessment meeting Incidence (Events per year)

Control group

Impact

Noted

Counties/ Manukau Started in South and Central Police Areas in April 2016 Expanded to East and West Areas in June 2017. Access database

~15–20,000 per annum 30–35% involve charges that are pursued Geographic case/ control comparison

Tairawhiti Started in May 2017. Retained a concentration of WNPH in a part of the district for a year then extended to all.

Auckland City District-wide roll out in May 2019. Follow-up of offending to June 2021.

Southern District Concentrated in Opotiki, started Nov 2019.

Constructed spreadsheet/family safety system

Family safety system

Family safety system

~10,000 per annum 30–35% involve charges that are pursued

~15,700 per annum 14% involve charges that are pursued

~11,000 per annum 14.5% involve charges that are pursued

Propensity-matched Natural experiment and Random Control (before/after comparisons design) Evaluation draws a sample from 100 days following May 2017

Natural Experiment (Before/after Design) and Propensity-­ matched comparisons Follow-up data through 20 months of data. Almost 50% Average harm per Fewer offences Matched reduction in offence reduced by with lower average comparisons show harm from 20%. 40–50% harm (about half reduction in reoffending reduction in first the rate expected offending of compared to time offences after from those with no around 26%. those in control ‘5f’ events. Overall contact with Calculated benefit group. reduction of 18.7% WNPH). For those to the district (over Calculated to calculated based on that re-offend, 2 years is 19.5% reduce harm by estimated impact for reduced severity by reduced overall 15% across the 2 years. around 22%, crime harm) district. reducing the overall harm by 15% 16,000–20,000 Noted an impact of Noted lack of a Reduction directly events flagged as WNPH on those formal control linked to WNPH family harm, exposed to WNPH group. via matching of most perpetrators because of a 5F-only FSS-plan not seen within event (i.e. no performance to the past arrests). re-offending 12 months. outcomes.

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particularly able to deal with such. The quasi-experimental methods that use big data provide a wayfinder, a measure of programme success, and confidence that the whole approach succeeds. The problem, if there is one, is that these efforts do not describe the mechanism for it. They do not get to the cause of the change; they do not explain why WNPH works. Knowing a response works does not address the fundamentals of why family harm occurs, and the evaluations of WNPH pass over silently those that never come to the attention of Police.

4 A Framework for Assessing Programme Effectiveness Big Data radically alters the opportunities for an informed police practice, with the almost real-time monitoring of actions amendable to analysis in ways that were practically inconceivable in 1984 when the Apple Computer Company launched the top-of-the-line MacIntosh in 1984, with 128k of RAM: A modern analysis would use a device with 100,000 times that capability. The New Zealand approach relies on structured administrative data (improved by the 5F App), complex data handling and the integration of a crime harm index assessing millions of files. Both Lawrence Sherman and Richard Berk independently moved to support a developing police science and to understanding complex practices such as how police address family harm. Sherman (1992) proposed evidence-based policing, drawing on the efficacy of the randomised control trial, declaring it to be the ‘most advanced research design for inferring cause and effect’ (p. 2, Sherman, 1992) (see also, Sherman, 1998, 2013). Berk took a different stance, considering the role of meta-analysis, review and evaluation (Berk, 2011). Like other jurisdictions, NZP has trialled, with and without evaluation, or research support, many components to its programme-wide efforts to reduce family harm. Some of these current interventions have evolved from previous programmes. For example, the WNPH program draws influence from multi-agency risk assessment conferences (see Robinson, 2004). Some components have been overturned in response to research evidence. For example, NZP abandoned risk assessments using the Ontario Domestic Assault Risk Assessment instrument in 2016 following an evaluation (see more recently, Hegel et al., 2022; Jung & Himmen, 2022). It adopted instead a localised two-stage risk assessment instrument, which is retained, even though it too has been found to have poor predictive capacity (Jolliffe Simpson et al., 2021). Readers from other jurisdictions may recognise that their police practices also run ahead of strong research support. Programmes are not usually directly founded on research, making Sherman and Berk’s (1984) experience even more extraordinary. New practices tend to be built on blend of research-informed experience, a pragmatic approach, referred to in philosophy as abductive reasoning (Kitchin, 2014). Some jurisdictions are well-equipped with a willingness to trial new ideas, including the establishment of evidence-based policing units, the adoption of crime harm indices (Andersen & Mueller-Johnson, 2018; Neyroud et al., 2020; Ransley

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et al., 2018; Sherman et al., 2016) and linkages to researchers and funding (Lum et al., 2012). In New Zealand, these developments were directly attributable to the advocacy by some. The position of current practice can be outlined. Following Bowling et al. (2019) we have placed 16 components of the NZ practice, over which police or courts have some influence (see Table 10.2). Each of the component parts has some degree of assessment in either a research literature or via direct evaluation specific to the implementation in NZ. Table 10.2 outlines the hypothetical effect of the intervention and is ordered into the four groups: (1) currently implemented practices; (2) trialled practices that are yet to be widely adopted; (3) past practices, now rejected; (4) research-informed promising new practices. An assessment of the overall effectiveness of the practice is offered, with the most relevant research evidence being cited in support of that assessment. Some well-regarded practices have extremely limited support, such as the use of police-issued separation orders (Polaschek, 2016), known locally as police safety orders (PSOs). The initially trialled 24-hour version of the PSO was evaluated (Mossman et  al., 2014). However, to date, there is no direct evidence to further establish the benefits of PSOs. The exception is in the observation that PSOs are perceived to be effective because they were expanded after a pilot implementation with legislation allowing an officer discretion to apply a PSO for up to 10  days. Elsewhere this type of extension of Police power is highly contentious (Reeves, 2022). There is better recent consensus that court-issued protection orders have a small effect (Dowling et al., 2018) but any effect is observed to vary through the nature of the relationship of the victim to the offender and their criminal history (Cordier et al., 2021). However, evidence suggests victim-survivors will more likely contact police when protection orders are in place (Birdsey & Snowball, 2013). Thus, in Table 10.2 we have described protection orders as having two mechanisms of influence: (1) Reduces re-offending and (2) Increases victim participation. The latter is an indirect or intermediate measure of what works to reduce overall family harm. Training Police officers to being sensitive to victims and recognise their vulnerabilities is contained as a strategic goal in the New Zealand national strategy for dealing with family harm. The call for improved training is ubiquitous in the research literature. Studies do suggest that the knowledge and demeanour of officers affects the likely engagement of victims (Stephens & Sinden, 2000) so this is the likely mechanism for considering improved training as effective in reducing family harm. Researchers, however, tend to measure improvements in police officers’ knowledge and attitudes following training. A notable exception to the usual approach is Ruff (2012) who found differences in the types of response offered by officers following training. This still falls short of establishing any specific sorts of training as being effective for reducing family harm. Newmark et al. (1995) illustrate the difficulty of linking training to changes in baseline offending data. The trial of victim video statements is an innovation that is well advanced in New Zealand, arising concurrently with the early uptake of smartphone technology. The new practice attempts to encourage victim participation in providing statements, giving them voice and removing a barrier to advance arrests and court processes.

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Table 10.2   Following Bowling et al. (2019) the table summarise the position of the components New Zealand’s current Police-led, or Court-led actions Currently adopted national interventions The use of police-issued safety orders (PSOs) to separate parties for up to 10 days. Officer training in the sensitivity of victims and their vulnerabilities. Community/police partnerships with triaged actions and community referral Court-mandated bail conditions (including electronic monitoring)

Underlying hypothesis Reduces offending Increases victim engagement

Effectiveness Inconclusive Effective at increasing victim engagement Conditional

Evidence Kothari et al. (2012), Mossman et al. (2014)

Reduces offending

Effective

Reduces re-offending

Ineffective as a standalone mechanism Conditional Inconclusive Effective at improving judicial processes

Mossman et al. (2017), Walton (2021), Walton and Brooks (2019, 2020) Bartels and Martinovic (2017), Nancarrow and Modini (2018)

Improves victim participation

Improves victim Victim video statements/ digitally recorded evidence at participation Improves judicial scene processes

Inconclusive Static and dynamic risk scores Improves officer for offender assessment. decision-making ⇒ Reduces offending Improves victim Effective Social marketing campaign (targeted at offenders/attitudes participation towards family harm). Court-issued protection Reduces offending Conditional orders. Improves victim participation Trialled and evaluated practices that have not been adopted widely Specialist family violence Improves victim Effective courts. participation and reduces re-offending Men’s sheds/Gandhi Nivas Reduces offending Effective initiative. Inconclusive Victim/offender proximity Improves victim alarms. participation/ reduces re-offending Inconclusive Police-issued victim panic Reduces alarms. re-offending Increases victim participation

Breci (1989), Newmark et al. (1995)

Backes et al. (2018), McCulloch et al. (2020), Walton et al., (2018), (2021), Westera (2016) Jolliffe Simpson et al. (2021) Flood (2011)

Cordier et al. (2021), Dowling et al. (2018)

King and Batagol (2010), Koshan (2018), Stewart (2005), Cook et al. (2004) Morgan et al. (2020) García (2016)

Hodgkinson et al. (2022)

(continued)

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Table 10.2 (continued) Currently adopted national Underlying interventions hypothesis Effectiveness Evidence Historical practices that have been largely abandoned Pro-arrest/mandatory policies Reduces Ineffective Op.cit (pp. 1–9) re-offending Garner et al. (2021) A ‘reluctant intervention Reduces Ineffective Carswell (2006) approach’ re-offending Practices that have not been adopted but have some evidence to suggest they work Inconclusive Cismaru and Lavack Encouraging victim reporting Improves victim participation (2010) (through a social marketing campaign) Inconclusive Holtzworth-Munroe Improves victim Alternative et al. (2021), Strang resolution/restorative justice participation and and Braithwaite (2002) reduces practices for family harm. re-offending

They are found effective at increasing early guilty pleas but have not been assessed for whether they reduce re-victimisation or re-offending (Walton et al., 2018, 2021). The problem with our current knowledge of victim video statements is that they either enhance or remove victim agency as measured by the participation of victims. The measure that they induce early guilty pleas simply passes by this important question. This finding has not stalled a nationwide roll-out of the practice, including required changes to regulation of the Evidence Act to facilitate their use. There are also programmes that are indirect to police action. For example, social marketing campaigns intended to reduce family harm (see Hastings & Domegan, 2017) are either directed towards the aggressors (Robert et  al., 1999) or towards victims (Cismaru & Lavack, 2010). Such campaigns are effective at increasing victim participation (Flood, 2011) but whether they ultimately reduce family harm is still quite uncertain. To be complete, the remaining components of the New Zealand response are listed in Table  10.2. The table offers the mechanisms for the effect through the hypothetical relationship to reducing all family harm and deliberately considers both the impact on a victim and the impact on an offender. In the practice of evaluation this is usually referred to as the logic model, a key requirement for effective consideration of practice (Centre for Disease Control, 2020). Table 10.2 shows that research has multiple influences on outcomes. Re-offending is quite different from offending, and most of the component parts of the programme express their influence through improving victim participation whether they are effective at doing so. The assessment of effectiveness should illustrate that the relationship between research and practice would be considered woeful when set against the standards set by researchers (Farrington et al., 2002). Some component parts are directly assessed within developed trials, or single evaluations (e.g. family violence courts). These programmes are listed as effective but are not built out of extensive meta-analyses, they are commonly supported by simple case/control methods used in evaluations. 

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Fig. 10.1  A two-dimensional array indicating the research-informed basis for the trialled practices (see Table 10.2 above) leading to the current position of New Zealand Police’s response to family harm. What ‘probably works’ is considered as reducing the incidence family harm whether or not the dependent variable of the research was a direct measure of such

Figure 10.1 is a simple two-dimensional grid on which we have located each of the 16 police and court actions identified in Table 10.2 above. It is not simply a summary of the position; it can be used to support conclusions about new practices as new research becomes available. It also allows us to draw conclusions about the state of evidence supporting the current position. A similar approach adopted by Lum et al. (2011) is the matrix model but here we limit our focus to family harm, and use the illustration to graphically locate the state of our assessment of the current practices that comprise the response to family harm in New Zealand. Polaschek’s (2016) review of perpetrator programmes usefully characterises three categories of actions against primary aggressors: (1) punitive, (2) containing and (3) rehabilitative. For our purpose these three categories can be placed on a single broad dimension of prescribed – informal decision making, locating the action within formal processes or determining the practice involves an informal resolution. Punitive

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programmes require formal practices with prescribed decision making, such as usual court-based programmes. Informal structures maybe still highly prescribed but include discretionary actions of police officers, such as the decision to arrest or issue a PSO.  These informal structures allow a case-by-base or individualised response (Stanko, 1995). Polaschek noted that alternative resolution programmes fell outside her consideration but located these with the rehabilitative rather than punitive processes. Any action taken against the perpetrator necessarily also impacts on the victim. This point is argued for strongly by Stanko (1995). Indeed, the distinguishing feature of family violence is the dependencies between victim and perpetrators, whether personal, economic, social (Hoyle & Sanders, 2000) or legal, as is the case between child aggressors against parent victims (Moulds et al., 2019; Walton et al., 2021). An action taken against a perpetrator has a significant, at least indirect, impact on a victim or victims. For this reason, we provide a victim dimension which addresses actions that remove or reduce or enhance or empower victim agency. Figure 10.1 illustrates three aspects of the current literature: (1) family harm actions are usefully considered multi-dimensional; and (2) there is a tendency to locate the successful practice in the regions that enhance victim agency and avoid formal structures (not the top right quadrant). A stronger argument might be that the factors that are known not to work are distinguishable from those that do (i.e. they occupy a different location on the dimensions); (3) The grid structure adds the opportunity for any new action to be considered and highlights the need to recognise that what works might be better informed by evidence that considers outcomes for victims and outcomes for perpetrators. Thus, the main benefit of Fig. 10.1 for the practitioner is the dimensions, not the research studies. We encourage others to also locate their research, practices and assembled evidence against these dimensions as a means of assessing the relative merits of their own position. Finally, in offering these dimensions, which they may well be altered, contested or expanded, we are in essence positing a theory from which there are several derivable, and testable, principles: (1) police or court actions that remove victim agency lead to negative impacts; (2) limiting police officer discretion in favour of highly prescribed actions leads to less victim engagement and consequently poorer programme outcomes; and (3) the more adapted a response is to the perpetrator/victim circumstances, the more likely the intervention will succeed. We suggest that these principles are also derivable from a narrative rather than meta-analytic review of the state of the literature.

5 Conclusions A long tradition of separately considering victim-survivor and perpetrator outcomes lies at the heart of our analysis of the overall problem of research failing to support police actions on what works. We contend there is a dynamic relationship between these system responses – they are, for all practical purposes for frontline officers, the same thing. The bifurcation in research manifests in the obvious limitation on

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most studies focused on non-programme-wide, quasi-experimental (or even randomised controlled trials) designs: these methods are blind to when victims disengage with the processes employed either to the intervention or the research. This creates a methodological conundrum that is not easily resolved. The remarkable journey of those pioneering police science has manifested itself in one of the most substantial influences in social policy from which emerged the need for the new discipline of police science, and the emergence of evidence-based policing. The narrowing of the definition of family harm to IPV, and then, for example, only that of misdemeanour assaults, is perfectly reasonable in a research environment that tilled the ground nearly 40 years ago and developed it thereafter. Research informs a component part of police practice, so we can expect officers might be trained to have different responses to IPV, compared to parent/child dyads. What is not quite right (at least because it commits the fallacy of composition) is to inform the whole based on the part. In assembling what works, one cannot inform the total practice from a single study, or even a set of studies narrowed to a small region of the total behaviour that police deal with. Family harm is not only IPV, and police struggle to be informed based on even the very best research evidence focused on limited assessments of components of what they do. Police, courts and government will continue to try new approaches. They will maintain an enthusiasm for research support, and even run ahead of strong evidential research support. However, a bottom-up, research-led inquiry that radically alters policy is never likely to be repeated. Rather, a slow accumulation of evidence will inform changes in practice. The advent of the big new data paradigm should be embraced, it has the same effect for practice as groping around in the dark and finding the light switch. What is finally illuminated might be disordered and chaotic but at least we can move around it with better confidence. The evaluations of programmes in New Zealand are intended to do exactly this: they inform progress, they do not define it. We should not concede to the complexity of the subject matter, but we should not hope that the problems will be overcome by more and more research, or by thinking more, and more, meta-analytically. The history of science is full of examples of overcoming what was once too complex, by the efforts of scientists to reconceptualise, measure in new ways, and apply new technologies (Nagel, 1961). The promise of a new paradigm of big data, and new methods of measurement, such as crime harm indices, is to use the available data and to systematically measure exactly the outcome that is ultimately sought: the relationship between action and the reduction in family harm. Using modern techniques of evaluation promises to support the efforts of researchers and practitioners to find new ways to reduce violence in families.

References Andersen, H. A., & Mueller-Johnson, K. (2018). The Danish Crime Harm Index: How it works and why it matters. Cambridge Journal of Evidence-Based Policing, 2(1), 52–69. Ariel, B., & Sherman, P.  L. W. (2012). Protocol: Mandatory arrest for misdemeanor domestic violence effects on repeat offending. Campbell Systematic Reviews, 8(1), 1–30.

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Chapter 11

Police and Intimate Partner Violence Risk Assessment: Searching for Evidence-Based Effective Responses Juanjo Medina and Andy Myhill

More than 40 years have passed since the National Institute of Justice funded the Minneapolis Domestic Violence experiment (Sherman, 1992). That study, focused on testing the deterrent impact of arrest on misdemeanor domestic assault cases, represented a pivotal moment in the history of policing domestic abuse and encapsulated the concern among academics and police practitioners that change was needed to provide a better response to victims. It also, through the impact it had in the adoption of mandatory and preferred arrest policies, significantly increased the volume of cases that required a greater police involvement in this domain. This shift toward greater criminalization, that adopted various forms across the global North, was a common feature of the wave of reforms affecting the policing of domestic abuse; the other was an initially uncritical and naïve trend toward generic solutions that could work across a wide variety of domestic abuse scenarios. But even in this early stage there was an increasing realization that domestic abuse was a convenient term that included a wide variety of situations and that generic solutions may not be appropriate in all scenarios. This was most evident in Sherman’s (1992) interpretation of the Spouse Abuse Replication Program findings that tried to replicate the initial Minneapolis findings. For Sherman and his colleagues (1992) these new findings provided evidence that arrest could have a detrimental counterproductive criminogenic effect when used against those with few stakes in conformity (e.g., persons who were unemployed). Subsequent work by Michael Johnson (2006) on typologies of abuse (situational couple violence, intimate terrorism, violent resistance, and mutual violent control) and authors such as Amy Holtzworth-Munroe (2000) on typologies of abusers reinforced the idea that J. Medina (*) Universidad de Sevilla, Seville, Spain e-mail: [email protected] A. Myhill College of Policing, London, UK © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 P. Sturmey (ed.), Violence in Families, Advances in Preventing and Treating Violence and Aggression, https://doi.org/10.1007/978-3-031-31549-7_11

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not all cases of domestic abuse are the same and we may need differentiated responses. Although Walker’s (1980) theory of a “cycle of abuse” popularized the idea that after onset abuse can only increase in frequency and seriousness, her own original data were not supportive of this notion (Medina, 2002). Subsequent longitudinal survey research already in the late 1980s and mid-1990s found that the “cycle of abuse” of continued escalation was uncommon (O’Leary et al., 1989; Quigley & Leonard, 1996) and cessation of violence in a three-year period could be observed in two-thirds of the cases (Aldarondo, 1996). Though some authors continue to suggest (without longitudinal data) a general trajectory of escalating physical violence that will be observed “if the resilience of the victim is compromised because of lack of access to structural, especially economic, resources” (Walby & Towers, 2018, p.  8), in reality there are likely to be multiple trajectories for the escalation and desistance of abuse (Myhill & Kelly, 2021). In addition, work with victim-survivors suggests in some cases physical violence may desist while non-physical coercion and the threat of physical violence is maintained. More recent work by Bland and Ariel (2015) using a large police data set (N = 36,000) found that in 76% of the dyads there were zero repeat calls in a five-year period and that among the 727 dyads who called the police 5 or more times, there was no evidence for escalating harm severity, but some evidence of increasing frequency. Critically, using the Cambridge Harm Index, they reported that less than 2% of dyads accounted for 80% of all domestic abuse harm. Even assuming we need a more appropriate measure of harm, the “power few” principle that the majority of harm is attributable to a small minority of perpetrators (Sherman, 2018) is probably a valid representation of the phenomenon. This concentration of harm and patterns of discontinuation have also been reported in other domestic abuse studies using similar data and imperfect measures (Barnham et al., 2017). Lacking valid, non-police longitudinal data and better measures of harm many of these debates about escalation and concentration will not be resolved, but, at the very least, this evidence base points to the need to differentiate responses on the basis of heterogeneity of encountered situations and to focus our attention in those cases that are unlikely to present a pattern of discontinuation without some form of external intervention. One of the first attempts to reconcile the need to improve police responses to domestic abuse with the recognition of this heterogeneity, and the need to manage the increased volume of work, was a repeat victimization project implemented in the Killingbeck Division of West Yorkshire Police in the city of Leeds (UK) (Hanmer et al., 1999). The project aimed to reduce repeat victimization with perpetrators and victims through a three-tiered model of increased intensity intervention as the case moved from Level 1 to Level 3. With repeated attendance required from the police the level of intervention moves from Levels 1 to 2 to 3. The model was based on the idea that “decreasing victim suitability and demotivating offenders require the application of progressive measures of intervention to constrain the offender’s future actions” (Hanmer et al., 1999, p. 3). The quasi-experimental evaluation of this demonstration project claimed reduced repeat attendances and increased time intervals between attendances, and a reduction in the number of chronic repeat

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offenders. Whatever the merits of the program, it failed to be adopted more widely. Yet, it became the direct inspiration for much later transatlantic experiences, such as the focused deterrence High Point Offender Domestic Violence Initiative (Sechrist et al., 2016), and it preceded the more general risk assessment models that provided differentiated responses to domestic violence cases according to the level of risk (often heavily influenced by prior victimization).

1 The Advent of Intimate Partner Violence Risk Assessment As we saw, the initial attempts, as in the Killingbeck pilot, to identify cases requiring more intensive police intervention were based on quick assessments of the history of previous incidents. But this would eventually change, as tools devised for other application settings, such as public health and probation, started to be developed for the purposes of assessing the risk of domestic abuse. In the United States and Canada, various tools were developed during the 1990s to identify victims at a high risk of a new, particularly more serious, assault. The basic aim of these tools was to distinguish among cases that have a higher probability of a new assault or a particularly serious new assault. They typically included risk factors identified by the descriptive literature as being correlated with domestic abuse or particular forms of intimate partner violence (IPV), and may be related to the victim (e.g., pregnancy, isolation), the perpetrators (e.g., prior records, access to weapons), the relationship (e.g., separation, escalation of violence, financial problems), or the community (e.g., social exclusion, lack of support). These tools could generally be classified as actuarial or structured clinical judgment tools. Actuarial tools compute a risk score or classification based on the presence of particular risk factors, which may be weighted according to their importance. Structured clinical judgment tools typically include similar risk factors identified as important by the literature, but conclusions about their impact and the overall risk classification allows for greater professional discretion and subjective judgment on the part of the assessor. Two of the best-known instruments that were developed during the mid-1990s included the Danger Assessment (Campbell et al., 2009) and the Spousal Assault Risk Assessment (SARA) (Kropp et al., 1995). The Danger Assessment was developed by Jacquelyn Campbell, professor of Nursing in John Hopkins University, as a statistical risk factor assessment based on a review of empirical research on risk factors for homicides in violent relationships. As such it was conceived as a tool designed to assess the likelihood of lethality or near lethality in IPV situations. It was intended as an informal mechanism that could be used to inform discussions with battered women in shelters, healthcare and counseling settings, and decision taking in court decisions. It was designed to be administered to victims by an advocate, healthcare professional, or criminal justice practitioner as a sort of questionnaire with 20 yes/no items about risk factors that could be present in the last 12 months. It was subsequently modified and the risk factors weighted to develop a scoring algorithm with different levels of risk (Campbell et  al., 2009). This was

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followed by the development of a so-called “culturally competent version” that could be used with immigrant women (Messing et al., 2013) and a shorter version that could be used in healthcare settings (emergency and urgent care), in which a longer version could be difficult to use (Messing et al., 2017). Whereas the Danger Assessment represents a good example of an actuarial tool, the SARA is the paradigmatic example of structured risk assessment in this area. The SARA (Kropp et al., 1995) was initially composed of 20 items that had been identified by the literature on wife assault (Cooper, 1993). Kropp and his colleagues (1995) emphasized that this is not a test aiming to provide measures of risk with cutoff scores or norms, but rather the instrument aims to structure and enhance professional judgments about risk; it acts as a checklist one needs to go through before forming a professional judgment. The evaluator has to score the presence of each factor as absent, subthreshold, or present. It allows for the person completing the assessment to override suggested recommendations on the basis of critical items, those that given the circumstances could be considered to be sufficiently serious on their own to compel the evaluator for a higher assessment of risk. It was never conceived as a psychological test that only a qualified psychologist could administer, but it is clear that this type of device requires sufficient training to allow for good professional judgment to be exercised. The original field of application was probation practice in the context of informing pre-trial assessment, pre-sentence reports, sentencing decisions, etc. In this court-correctional setting, the risk-needs-­ responsivity model (Bonta & Andrews, 2007) suggests the need to identify the perpetrators at highest risk for whom treatment will be most beneficial, and the need to identify the criminogenic needs that are amenable to intervention. Given this context of application, it was intended to be completed after interviews with both victim and offender, and a review of existing criminal justice information on the case. Neither of these two early tools were originally conceived for use by police officers. But as their popularity increased for use in other settings, we started to see adaptations and versions of these and other similar instruments to be employed by front line police officers and second responders. And so, shorter versions of the Danger Assessment were eventually designed to be used by front line police officers, such as the Lethality Screen (Messing & Campbell, 2016) or the Danger Assessment for Law Enforcement (Messing et al., 2020); and shorter adapted versions of SARA, the Brief Spousal Assault Form for the Evaluation of Risk (or B-SAFER) were also developed for the same purpose (Kropp et  al., 2005). The explicit assumption in many of these adapted scales and others similar scales is that front line police officers do not have the same skill set nor the time as specialized counselors or advocacy figures for more sophisticated and exhaustive risk assessment. In this way, although risk assessment had first developed in other settings such as healthcare, advocacy, and probation, we saw during the new millennium the expansion of this practice for the management of IPV to the policing environment. This was consistent with the increasing risk logic permeating all criminal justice practice and policy (Ericson & Haggerty, 2008; Harcourt, 2006) but it was also perceived in policing circles as a solution for the much-needed improvement in the quality of

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police responses to IPV. Critically, risk assessment allows the police a way to process the very large volume of demand in IPV in an objectified way that allowed for a more rational allocation of limited resources. For example, in England and Wales the police had to process 845,734 domestic abuse-related crimes in the year ending March 2021. Although the initial literature and impetus for IPV risk assessment developed in North America, it has been in Europe where the risk-led approach to the policing of IPV has probably had a more significant impact. This is a direct result of the European Union Victims’ Rights Directive. In article 22, this directive calls specifically for individual assessment of the victim by relevant services, and promotes a case-by-case approach toward victims. In addition, the Istanbul Convention, signed by the European Union, in article 51 established the obligation of relevant authorities to effectively assess and devise a plan to manage the safety risks a particular victim faces on a case-by-case basis, according to standardized procedures. As a result, “the majority of E[uropean] U[nion] Member States have risk assessment and/or risk management embedded in some form of policy document and/or national legislation on intimate partner violence” (European Institute for Gender Equality, 2018, p. 16) with the police and other criminal justice actors adopting the lead role in these processes. SARA, B-SAFER, the Danger Assessment, Ontario Domestic Assault Risk Assessment (ODARA) (see below) were all developed in North America but are currently used variously across Europe. Some European countries, as we will see, have developed their own ad hoc tools and systems. Increasingly, there is a broader concern to adapt these tools so that they better capture risk not only to the primary victim but also to children in the family.

2 Models of Intimate Partner Violence Police Risk Assessment Police risk assessment is not all the same. Aside from their characterization as actuarial or structured professional judgment tools, police risk assessments can be distinguished in a number of other relevant dimensions (e.g., victim- vs. offender-focused; oriented to predict re-assaults vs. more serious forms of assault; carried out by responding officers at the scene vs. carried out by specialized follow­up units; centered on IPV or more generally oriented toward domestic abuse). We argue there are at least, in the comparative context, three general models of police domestic abuse risk assessment. The key distinguishing criterion across these models is the kind of information used for the purposes of risk assessment. Focusing on the kind of information needed and used, we think it is important because it shapes in a critical manner the infrastructure required for putting them into place, and the challenges and limitations they each present. Although these tools differ in the way the final risk classification is computed or decided, almost all allow for some degree

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of officer discretion to override the classification the various models offer. We described these systems below.

Risk Assessment Using Police Administrative Data This model heavily relies on the use of secondary administrative police and other criminal justice data. Tools such as the Danger Assessment or B-SAFER require interviews with victims and are scored primarily on the basis of these interviews, often even the items are worded as if they were to be administered as an informal survey. But other approaches to risk assessment rely primarily on the use of information already available in police systems. The best example of this approach is the ODARA (Hilton et al., 2004), which relies on variables readily obtained by front line police officers, most of which can be documented by analyzing the previous criminal history of the dyad (e.g., prior domestic incident, prior non-domestic incident, prior custodial sentence of 30  days or more, failure on prior conditional release). ODARA is an actuarial risk assessment that ranks the men according to their probability of recidivism and that was developed in Canada at the outset of the new millennium (Hilton et al., 2010). The higher the score, the higher the probability of recidivism. Most of the 13 ODARA items can be ascertained by checking the participants’ criminal record, but the information can also be complemented by information provided by the victim and typically included in the initial reports from the responding officers. It is not a questionnaire but a list of risk factors with clear instructions on how to ascertain their presence and is designed to be completed back at the police station, rather than in the heat of the moment. Another slightly different example of this kind of approach is encapsulated by the Priority Perpetrator Identification Tool (Robinson & Clancy, 2015, 2021) for identifying those perpetrators requiring a greater degree of scrutiny and supervision. It was designed to be used by relevant agencies in the criminal justice system and the specialist support sector, and includes 10 items to structure professional judgment. Practitioners are encouraged to evaluate whether there is evidence for the items - most of which are focused on aspects of the perpetrator’s behavior such as escalation, serial violence, and access to weapons. The items are rated to be present or absent for both recent (within the past 6 months) and historic timeframes. A distinguishing feature of this particular tool is that in spirit it was designed to stimulate conversations and collaboration in multi-agency settings, so that practitioners from different agencies and the specialist support sector could exchange information for the correct identification of those offenders requiring a closer look and management. Although in principle a police department could use this tool internally for its own purposes, Robinson and Clancy (2021) argued for the potential benefits that could arise from its deployment as part of collaborative, risk-led initiatives and, in the pilot evaluated, noted how its use became a method that helped to enhance, and refine existing working relationships.

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A more recent iteration of this approach is being driven by the application of data science under the glitter of “predictive policing” and its promise for most efficient crime control (Brayne, 2020; Ferguson, 2017). Recent years have seen the application of machine learning methods for the purpose of improving the predictive potential of risk assessment tools in criminal justice (Berk, 2018). Tools, such as the ones described, until now were based on a small subset of risk factors identified by the IPV literature. Subsequently, the approach in some of these applications has been to take a broader set of variables available in police data sets and mine them using more sophisticated machine learning algorithms that could help to improve the quality of the predictions. Grogger et al. (2021) employed 20 variables including perpetrator gender plus 19 different measures of criminal records to develop a model to predict serious violent revictimization using random forests and logistic regression. Similarly, also using British data, Turner et  al. (2021) used a logistic model with an elastic net on a broader set of variables typically available in police data. Proponents of these approaches have suggested that they may improve the quality of risk assessment without imposing a significant burden in police resources. Grogger et al. (2021) also noted that their model could be implemented in such a way that dispatchers to an IPV incident call could provide preliminary information to responding officers about risk, whereas previous risk assessment tools (e.g., ODARA, SARA, or the Danger Assessment) can only provide a risk classification at a later stage. A key advantage of this type of approach is that it does not require much new additional data collection, reducing the burden on officers and victims. In some cases, like in the machine learning applications, it is a matter of reusing existing administrative data; in others, like with the Priority Perpetrator Identification Tool, it is a matter of information exchange across agencies. A key limitation of this model, on the other hand, is that it relies on the unbiased and accurate recording of data by police practitioners and it does not incorporate any additional information that may be relevant to understand risk factors for revictimization and reoffending and that may not exist in the administrative datasets. For this to work, all police forces need is a decent enough IT system that allows convenient retrieval of historic information, an adequate identification system to track historical cases to named individuals in new cases, software to compute the risk scoring, and an appropriate interface for the officers to use. Anybody with experience working with police data knows these things are not that simple. In countries without a compulsory national identification system, it is not easy to link administrative records concerning individuals without error: tracing the criminal history of an individual can be difficult. Police recording of crime is not perfect either. There is, for example, evidence in England and Wales of a near industrial scale under-recording of crime that has only recently improved in some parts of the country. Audits of police systems suggest that under-recording of violence against the person was as high as 33% (HMIC, 2014a) and is still a serious ongoing problem in some police forces (HMICFRS, 2020). Critically, this model places too much faith on the capacity of police administrative data to capture all the nuances of IPV, even when we know that there are reporting biases more pertinent for

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non-physical violence, and that police data offers limited information on non-­ physical violent forms of abuse that comprise part of what Stark (2007) calls coercive control. Finally, the scoring will only be as good as the information one has. In decentralized police systems where data sharing across law enforcement agencies is limited by jurisdictional borders this raises significant challenges.

 isk Assessment Using Short-Questionnaires for Front-Line R Officers Use Unlike the previous model, other police forces do their risk assessment by virtue of using questionnaires which are typically administered to victims by front line responding officers, or officers from specialized IPV units following up the initial police response. These questionnaires are heavily influenced by the risk assessment tools developed for other application settings and include risk factors identified as relevant in those previous tools. We have previously mentioned versions of SARA and the Danger Assessment that follow this approach. B-SAFER is an adaptation of SARA. It is a set of structured professional judgment guidelines designed for use by police officers and other criminal justice professionals (Storey et al., 2013; Svalin, 2018). It includes 10 perpetrator risk factors and five victim vulnerability factors. It is used by police departments in parts of Canada and it has been translated for use by police in a number of European countries. As with SARA, the presence of each risk factor is coded on a 3-point scale (absent, possibly/partially present, and present). The presence of each factor is coded to represent occurrences in the past 4 weeks or at any time in the past. After evaluating the risk factors, the officers are asked to produce three global ratings of risk: risk for recidivism, risk for threatening IPV, and risk for imminent IPV. The Danger Assessment for Law Enforcement, on the other hand, includes 11 questions that are asked to the victim at the scene of a police-related IPV incident. Each “yes” is assigned one point for a total score of 11 with a chosen cut-off point of 7 as the number of risk factors that referred the case for further review (Messing et al., 2020). Another similar tool is the Domestic Abuse, Stalking and Honor Based Violence risk assessment (DASH) in use by most British police forces. DASH, as recognized by its developers, also was influenced by the North American tools. The DASH was conceived as a structured professional judgment tool consisting of 27 items with yes or no questions, yet some police forces have adopted a threshold of 14 “yes” responses to indicate “high” risk suggested by an agency which coordinates the use of DASH by support services and other partner agencies. The final decision on the level of risk should, however, call upon the professional judgment of the officer. These various tools, in conception, are designed for use in particular ways. For example, the structured professional judgment required by B-SAFER is better made back at the police station with some pause, whereas the Danger Assessment for Law Enforcement could be easily completed at the scene of the call. But in practice they

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may be deployed in a variety of administrative arrangements. Robinson and her colleagues (2016a), for example, documented three varieties of administrative practices for the use for the DASH form across British police forces: 1. “Frontline officers identify risk factors via DASH interview at the time of an incident, but do not apply a risk grading; a risk grading is applied in all cases by a specialist officer or member of police staff. 2. Frontline officers attending an incident both identify risk and apply an initial risk grade and a secondary risk assessor reviews a subset of cases (those graded as ‘medium’ and ‘high’ risk by the frontline officer, or in some cases only those graded as ‘high’). 3. Frontline officers attending an incident both identify risk and apply an initial risk grade of ‘standard’, ‘medium’ or ‘high risk’. A secondary risk assessor reviews the initial risk grading in all cases.” (pp. i–ii).

As can be observed, the main difference across the three sets of practices is the degree of responsibility placed on frontline officers versus a secondary specialized police reviewer, and the corresponding degree of supervision and scrutiny that the initial risk assessments receive. These various administrative arrangements have an impact on the workload of frontline officers versus specialized officers in central units, and potentially also have an impact on the speed and individual quality of the risk assessment process. With greater scrutiny or responsibility from secondary risk assessors, the likelihood of delays is greater but the added scrutiny potentially may result in better quality assessments. A key point we want to emphasize is that adoption of any particular variety of risk assessment has resource and systemic implications that need to be properly considered. A key advantage of risk assessments based on victim interviews is that, at least theoretically, this model allows us to capture aspects of domestic abuse risk factors that are not typically embedded in police procedures that could be mined as in the previous model. A key limitation is that places a significant burden on officers and victims. As we have noted elsewhere (Medina et al., 2016): “Responding to a call for service is … an often rushed and stressful endeavour, not always the best setting for establishing the rapport necessary for securing a full disclosure to sensitive questions. Furthermore, the officers and citizens involved in these interactions are often encountering each other from very different gender, ethnic, and professional vantage points. An endless combination of misunderstandings, judgment errors, and procedural mistakes can occur in the policing of domestic abuse at the frontline” (p. 342). Not all officers are equally equipped and motivated to complete these questionnaires with the level of care that is required (see Myhill et al., 2023); nor can we expect them to deliver the level of diagnostic that a trained healthcare or clinical psychologist can provide. Victims may be reluctant to open their hearts to police officers, particularly if the context in which these questionnaires are being administered is not conducive to establish rapport, or if the victims come from social groups with a history of difficult relationships with the police. Adequate use of these forms requires appropriate training, and this sometimes is lacking (Robinson et al., 2016a). The fact that all the work is done by a single questionnaire means that a victim with repeated contacts with the police may come to experience the administration of this

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risk assessment tool many times, even when it is the case that there is an element of redundancy when asking questions about static risk factors. As we will see later on, it is yet unclear whether all this additional data gathering is worth the effort, at least for purposes of victimization prediction. This model also brings with it an administrative burden on police forces that have to develop appropriate protocols and IT systems for managing, storing, and using this information.

Risk Assessment Systems This third model constitutes in some ways a development from the previous one, but it presents some key differences. It is best exemplified with reference to the Spanish case system, VIOGEN (Garrido, 2012; González et  al., 2018; Zurita, 2014), the System for Comprehensive Assessment of Gender Violence, that has influenced development in other countries such as Portugal. Here we are not dealing simply with risk assessment forms, but with integrated management systems backed up by an ad hoc information technology infrastructure. Whereas with the previous model the key element is the risk assessment “form” (that shapes the decision making for a particular individual and incident), here the key element is the “case” (that gets registered in the IT system as “active” or “inactive,” depending on development) and that represents a particular dyad and history of incidents. This approach has the advantage of moving away from the incident-based lens that has often undermined police responses to IPV, where each report of abuse has traditionally been treated as a single and isolated episode or prompt for further intervention neglecting the fact that each incident may constitute an ongoing pattern of conduct with cumulative effects going well beyond the immediate consequences of each separate occurrence. Here we do not have a questionnaire the officer undertakes when responding to a domestic incident call but rather a form the officer accesses from a terminal and that has to be completed after a criminal complaint has been logged, and after a police report has been written by an officer. These forms are slightly longer and contain more risk factors than those we saw previously. In fact, there is not a single form but two forms. Currently, there is the initial 39-item form (version 4.0) that is used the first time a case comes to the attention of the police and the follow-up 43-item form. These follow-up forms are periodically used by the police for as long as the case is active, to assess changes in dynamic risk factors. This element of the model perhaps distinguishes it most clearly from practice in Britain where the DASH is generally administered only as a result of a (further) call to police. With VIOGEN, the frequency of the follow-up is contingent on the initial and subsequent risk classification: the more severe the last assessment is, the more frequent the follow-up assessments are. This multiple assessment represents an opportunity to correct unavoidable initial inaccuracies in risk classification. When we have a system that does not classify perfectly—and as we will see, violence risk assessment tools’ predictive metrics are far from optimal—doing multiple assessments that can help to minimize the presence of false negatives is highly desirable. Meteorological

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agencies are reluctant to provide weather forecasts based on complex models and ongoing physical precise live measurement for more than a few days ahead, yet in risk assessment we behave as if a once-administered risk assessment tool by police practitioners who are not always equally motivated, is going to be able to effectively gauge changing dynamics of risk in a violent relationship over a sustained period of time: This is not realistic. A system of ongoing assessment like VIOGEN seems a preferable practice. Because this system lives in an ad hoc information technology infrastructure used by most police forces in Spain, officers can access the entire historic record across relationships and within a relationship for both victims and offenders across jurisdictional boundaries within the Spanish state. Until now the risk classification was performed using a scoring algorithm based only on the responses to the risk factors in these two forms (Lopez-Ossorio, 2017), but the police authorities responsible for the system are experimenting, through collaboration with data scientists, on ways of using the historic information more efficiently (Quijano-Sanchez et al., 2021). The system has also been recently adjusted to provide a separate risk scoring for homicide (Lopez-Ossorio et al., 2021). A key feature of this system is that vetted and authorized non-police third parties (e.g., prosecutors, judges, and prison officials) can consult this database. These systems aim to incorporate some of the most positive aspects of the previous models while avoiding some of their disadvantages but they also have some challenges. It is probably not an accident that they only exist in countries with low levels of police decentralization; implementing something like this in countries without national police forces and with many incompatible information technology data systems may prove unworkable. The history of the Uniform Crime Reports in the United States is a testament of how difficult it can prove to do anything that involves data sharing in a highly decentralized police environment. It is also unclear what the quality of data gathering by police officers is, given the paucity of research in this particular area in countries that follow this model. Critically, unlike the second model, here we only capture and assess risk in cases that pass the threshold of being a criminal offense. If you go deep in the assessment, you are going to have to sacrifice breadth: there is always a trade-off that needs to be acknowledged. Thus, we need to recognize the potential reporting and recording bias in the resulting data.

3 Empirical Evidence for Model Effectiveness Predictive Validity Most research on this area has focused on trying to establish the predictive validity of the various approaches used for assessing risk. A number of systematic reviews have tried to compare the performance of various tools developed for this purpose across various settings, not only the police context. The early reviews reported small

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effect sizes for their classification accuracy, with ODARA showing a moderate effect size (Hanson et al., 2007; Messing & Thaller, 2013) and under certain circumstances the SARA.  These effect sizes are similar to those of predictive tools for general violence (Coid et al., 2009; Singh et al., 2011). A more recent meta-analysis (van der Put et al., 2019) including 50 independent studies and examining 39 different predictive tools, suggested an average moderate discriminative accuracy (Area Under Curve [AUC]  =  0.647). This meta-analysis suggested: (1) that these tools performed as well as risk predictions based on victim ratings and tools for predicting general/violent criminal recidivism; (2) that actuarial tools performed better than structured clinical judgment; and (3) that studies with better predictive accuracy tended to have poorer research designs. Finally, the onset of domestic violence was reported as being better predicted (AUC = 0.744) than the recurrence of domestic violence (AUC = 0.643). It is important to highlight that these systematic reviews, even though they include studies that evaluate assessment by police forces, are not focused on the use of these tools by the police and therefore do not specifically provide average effects for this particular setting. These meta-analyses have failed to include some of the most recent European analyses, in particular those challenging the predictive validity of DASH and using machine learning approaches to model data about these cases existing in police information technology systems (Grogger et al., 2021; Turner et al., 2019, 2021) or anything coming out from Spain about VIOGEN.  The Spanish research about VIOGEN suggested the initial VPR tool has an adequate performance (Lopez-­ Ossorio et al., 2016, 2019a, b, 2021), but when combined with the ongoing periodic assessment of VPER the performance improves well beyond the average reported above with an AUC of around 0.82 (Lopez-Ossorio et al., 2019a), and particularly if using more sophisticated algorithms that also account for this historical record of assessments (Quijano-Sanchez et al., 2021). There are five problems with the lessons we can infer from these studies. First, many of the studies have been directed and carried out by the same researchers that conceived these tools or are legally responsible for their management. This is an issue because there is a known authorship bias in this literature: “studies authored by tool designers reported predictive validity findings around two times higher than those of investigations reported by independent authors” (Singh et al., 2013, p. 1). Critically, this conflict of interest is not always reported in the publications. Second, these studies have been focused on trying to predict revictimization or recidivism defined in various ways. The problem is that the quality of these predictions will be affected by the extent to which there is bias in the reporting and recording of new incidents concerning the same victim or offender. This is an unknown quantity. We know there is such reporting bias with regard to the general population—IPV tends to be underreported—but we do not know the extent to which this bias affects the reporting of subsequent incidents once there has been an initial reporting. We need more research estimating this because it is fairly plausible that this reporting bias is present. We know, in England and Wales for example, that between 15% and 58% of cases victims end up not supporting police investigation or action (HMICFRS, 2019). In these scenarios, the likelihood that a new incident

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may be reported may well be diminished. Equally, as described above, the quality of police recording of particularly violent crimes leaves a lot to be desired. At the moment all research assumes that once an initial event comes to the attention of the police, subsequent police records provide a valid record of the trajectory of victimization. This is highly unlikely to be the case. Third, police systems offer an imperfect measure of non-physical forms of coercive control and related harm. Research and inspections of police forces reveal that officers still struggle to recognize coercive control (HMICFRS, 2019). We are validating these tools against police data, which means we are optimizing performance against mostly physical assaults which tend to be better reported and recorded than coercive control. This means we may not be adequately responding to other forms of abuse, in fact, we may be amplifying this problem by using this way of calibrating our tools, we just do not know at the present time. Fourth, if the police (responding to the initial risk classification) do something that changes the risk of victimization and we do not adjust in our statistical modeling for that “something,” our predictive metrics will be imperfect. Whether an officer assigns a particular level of risk typically determines the level of support a victim receives or the level of intervention provided to an offender, which may, optimistically and to some extent, influence whether or not another incident will occur. Among the false positives in any cases where a high risk was assigned but no new serious harm incident came to the attention of the police, there must be a mix of genuinely mis-labeled cases (where no new incident would have occurred regardless of subsequent treatment), and accurately labeled cases (where the police response averted further abuse). And so, it could be argued that we may be underestimating the power of the risk assessment tools. Unfortunately, police IT systems are notoriously bad at recording what happens as a response after the initial incident. At best, they may include some information about subsequent legal processing and whether there was or not a referral, but in many instances do not capture well other kinds of responses and interventions—particularly those that are not directly provided by the police but by the referral agencies or organizations. Some studies have tried to account for this (see Grogger et al., 2021; Peralta, 2015; Svalin, 2018) and suggest this is not a serious problem (perhaps because these post-incident interventions are not that effective), but until we have better and more systematic data on post-incident interventions the metrics for predictive accuracy have to be cautiously interpreted. Finally, almost all these studies have neglected issues of algorithmic fairness. There has been an increasing debate in the legal, criminological, and machine learning community about the fairness and ethical implications of algorithmic decision making, of which some of these actuarial tools are an example. Criminologists and legal scholars are increasingly concerned about the potential for bias and over-­ policing of certain individuals and communities that may result from algorithmic decision making in criminal justice and, specifically policing settings (Brayne, 2020; Ferguson, 2017). The first Fairness and Transparency in Machine Learning (FAT/ML) Workshop took place in 2014 at NIPS, the largest conference in Artificial Intelligence. The inaugural FAT Conference was in 2018. High profile reporting,

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such as the work by ProPublica (Angwin et al., 2016), has led to increased public scrutiny. There are now countless reports outlining the current state of affairs and providing guidance on defining fairness, and the remaining considerable challenges (Berk et  al., 2018; Chouldechova & Roth, 2018; Leslie, 2019; Partnership on AI, n.d.). The European Parliament in response to this debate adopted a resolution on Artificial intelligence in criminal law and its use by the police and judicial authorities in criminal matters (6th of October 2021) that “opposes the use of AI by law enforcement authorities to make behavioral predictions on individuals or groups on the basis of historical data and past behavior, group membership, location, or any other such characteristics, thereby attempting to identify people likely to commit a crime.” Although the resolution is less clear in other parts of the text, it is clear from the resolution the need to further study the social implication for over-policing of certain groups that may result from existing systems of algorithmic policing. ONGs, such as Eticas Foundation are, in Spain, asking for an ethical audit of VIOGEN. It is clear the dangers posed to human rights are numerous (Leslie, 2019; Wachter et al., 2018). On the other hand, the potential to improve outcomes such as the identification of high-risk victims of crime means that dismissing these methods out of hand is morally questionable at best. As more voices join the debate, from academia, government, industry, and other bodies, the only consensus is that we are not yet anywhere near a satisfactory solution to ensuring fairness in an algorithmic society.

Implementation Many of the studies about predictive validity were carried out in the context of particular pilots, often with involvement from the academics that had produced some of the risk assessment tools we have been discussing. Those studies are concerned with telling us to what extent these tools could potentially be helpful in identifying cases that require a more intensive response. But, from a policy point of view, it is equally important to understand the practical issues and challenges that arise when we try to change police protocols and procedures to ensure that officers adapt their working styles to use a risk-led approach to IPV. Research that describes how these tools and processes are used in real life is of critical importance. And yet, there is a certain imbalance in the research around this issue, for while the published evidence about predictive validity has been produced in various national contexts, most of what we know about implementation issues of large-scale adoption of a risk-led approach to policing is based on research conducted in England and Wales. Despite calls for an evidence-based approach to policing, in England and Wales, the DASH model was implemented in the absence of any published evaluation of its implementation or effectiveness although a process evaluation of one of the force-­ designed tools that preceded it identified issues with frontline officers’ willingness to complete the assessment for all cases, and increased workload for specialist

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officers (Humphreys et al., 2005). We know from international research that there is a set of individual-level including gender attitudes and organizational factors that affect the quality of the risk assessment process and that this quality indeed can be quite heterogeneous at the individual and organizational levels (HMIC, 2014b; Robinson & Howarth, 2012; Robinson et al., 2016a). More recently, a number of projects in which the second author has been involved have examined the implementation of DASH both by first responders and secondary assessors. These projects have involved analysis of data from DASH assessments, alongside interviews and direct observations of officers conducting the DASH interview with victims, and writing up the assessment. Robinson et al. (2016a) found the DASH was implemented inconsistently at the frontline, with officers recording information in an incomplete or inconsistent way, altering or omitting certain questions, or using discretion to not conduct a risk assessment altogether. Both first responders and secondary risk assessors were found to prioritize physical assault and injury at the current incident when making judgments about risk. The more recent report from Her Majesty Inspectorate of the Constabulary and Fire and Rescue Services (HMICFRS, 2019) continues to highlight that the quality and supervision of risk assessments still is not consistent across the forces and had to ask 11 forces to make improvements in this area. Myhill et al. (2023) identified inconsistency in the implementation of the DASH by first responders as resulting from a combination of officers’ attitudes to and understanding of domestic abuse in general and coercive control in particular, and issues relating to the design of the DASH questionnaire itself. Specifically, the loose and multi-pronged nature of many of the DASH questions and follow-up prompts lends itself to paraphrasing by officers, and the requirement to probe around the yes/ no questions and record free text data to contextualize victims’ responses was more suited to specialist supports services who have greater knowledge and training and engage with victims when they are not at a point of immediate crisis as is frequently the case following a call to police. Myhill et al. (2023) further identified from analysis of multiple DASH assessments an “officer effect” (e.g., variability across officers) in relation to the eliciting and recording of risk data. A multi-level model suggested the particular officer conducting the assessment influenced which questions were asked, what data were recorded, and whether in fact an assessment was conducted at all. Importantly, this “officer effect” was observed more in relation to some questions than others, with physical injury and more circumstantial factors (e.g., pregnancy, separation, substance abuse, and mental health) less likely to be affected than more sensitive questions and questions probing controlling and coercive behavior. Myhill et al. (2023) concluded it was difficult to be confident that any specific risk factor was present (or more crucially not present) in any specific case, which has clear implications for predictive models which have an underlying assumption of accurately measured input variables. Though smaller in scale, evaluation of the implementation of a frontline risk tool in New Zealand (Grant & Rowe, 2011) and further evaluation of the Lethality

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Screen (Richards et  al., 2020) found similar issues with lack of understanding among some officers and inconsistent application of the tools.

4 But Does It Work? The elephant in the room is clearly whether any of this makes any difference to victim safety or offender desistance. As noted above, most studies have focused on trying to understand how officers and police forces respond to the challenge of having to do the risk assessment and in trying to establish the degree to which the risk classifications made with these tools are accurate. Clearly these are relevant questions, but we cannot forget the bottom line for policing. Unfortunately, considerably less attention has been devoted to two critical questions: (1) are these classifications resulting in different and appropriate pathways of interventions for offenders and victims? and (2) are these different pathways of intervention effective in ensuring victim safety and other desirable outcomes? The short answers are that: (1) it is likely that the extent to which victims/offenders classified in different levels of risk receive an adequate response is heterogeneous depending on a variety of individual and organizational factors; and (2) we have limited evidence for whether the things we do to victims and offenders classified in different levels of risk are effective. This may sound discouraging, but we think it just points at where the real research needs are. There is still a lot of uncertainty about what kind of police interventions can be effective to increase victim safety and reduce offender recidivism. It would seem that calling the police and victim support do improve outcomes (Xie & Lynch, 2017), but we need stronger research designs and a better understanding of what in particular works and under what circumstances. There is persuasive experimental evidence that arresting perpetrators has a weak to moderate deterrent effect with some perpetrators (Maxwell et al., 2002). The evidence base for many other policing innovations in this arena is in some cases not very positive (e.g., second responder programs) or much weaker (e.g., focused deterrence, restorative justice approaches, improved investigation) and yet to be convincingly established (Davis et al., 2008; Sherman, 2018; Sechrist & Well, 2016).

Risk Informed Pathways of Intervention The way that police respond to the different levels of risk in relation to victims and perpetrators will vary by police force and country. Even within the same police department there may be differences in how responses are structured and organized within different subdivisions. The specific arrangements put in place may involve some degree of multi-agency collaboration with specialist support services, which adds an additional element of complexity depending on the richness of the local

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specialist support services environment. The various inspections and studies that have been completed in England and Wales to examine organizational arrangements to manage risk also suggest large variation across police forces (HMICFRS, 2019, 2021) that more often than not respond to different local cultures, and policies rather than to qualitatively different domestic abuse problems. The type of strategies deployed may include monitoring (e.g., repeated assessment or surveillance), controls or restrictions of freedom on the perpetrator (e.g., protection orders), intervention (e.g., voluntary brief perpetrator programs, referral to specialized services), and victim safety planning (e.g., identifying measures to increase victims’ safety and empowering them to adopt them). As an example, Table 11.1 describes how the VIOGEN system in Spain establishes distinct courses of action for cases at different levels of risk. There is, however, very limited research studying the extent to which recommended or required pathways of intervention per level of risk are followed through.

 he Effectiveness of Risk Informed Policing of Intimate T Partner Violence Some studies have suggested that risk-based policing of domestic abuse brings positive results, but the evidence base is limited. As noted by Cattaneo and Chapman (2011): “Instruments that rate the level of danger based on the presence of risk factors could be a component of an overarching strategy for managing risk, but research to this point has not focused on the development of best practice toward such end” (p. 1287). Although over 10 years old, this statement is as valid today as it was when first formulated. Or, as noted by the European Institute for Gender Equality (2018): “Risk management is under-researched, under-evaluated, and hard to link with risk assessment outcomes. There is a common - and significant - gap in data regarding the practice and efficacy of risk management strategies linked with risk assessment in the EU Member States” (p. 4). The same can be said elsewhere. We do not want to sound overly critical but changing police practices and systems to implement risk assessment protocols is a very significant resource-intensive undertaking, and it is unsurprising that much of the initial focus has been on the issues covered by research and practice so far. In England and Wales, cases classified as high risk via the DASH assessment are referred to Multi Agency Risk Assessment Conferences (MARACs). An early evaluation (Robinson, 2004) showed, using both police and victim self-report data, that there was no further victimization in 6 in 10 cases considered by MARACs. The success of MARACs, it was suggested, was down to better information sharing that allowed agencies to assist victims more efficiently. There has been little further evaluation, however, and, anecdotally, practitioners have questioned the effectiveness of some MARACs while struggling to resource the meetings with increasing caseloads. Further, the aforementioned variability in implementation of the DASH

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Table 11.1  VIOGEN protective measures for risk level Risk level Risk not appreciated Low

Medium

High

Extreme

Protective measures Provision of service and legal information for victim support Safety planning advice For the victim  Provision of 24-hour contact details and information about the mobile attention service  Referral to victim support and specialist support services  Ongoing phone or personal contact follow up  Tracking of legal development of the case (in civil and criminal jurisdiction) For the offender  Notification that the case is under police supervision and monitoring  Voluntary requisition of firearms and initiation of proceedings to withdraw permits  If needed (e.g., restraining order), accompany perpetrator to withhold personal effect from victim residence  Tracking of development of the case with probation and penitentiary service  Dissemination of details of the case to officers patrolling relevant areas For the victim  Ongoing personal contact with the victim  If needed, accompany victim to shelter  Occasional control of the victim’s residence, workplace, or school attended by children  Accompany victim to court of administrative services if considered necessary for her safety For the perpetrator  Request the prosecutor service to authorize GPS electronic monitoring of the perpetrator  Periodic control that the legal protective measures are being abided by  Personal communication with the perpetrator to ensure he understand his case is being monitored by police For the victim  If perpetrator has not been located, insist in temporal move to shelter or alternative accommodation  Frequent control of residence, workplace, and children’s schools For the perpetrator  Random control of the perpetrator and sporadic visits to those he socializes with For the victim  Constant protection until there is no imminent threat  More regular surveillance of children’s schools For the perpetrator  Intensive control of his movements

Note: Measures detailed in the Instruction 10/2007 from the State Secretary of Security

model has led some to question whether it is ethical to allocate interventions on the basis of the DASH assessment (Myhill et  al., 2023). Research has also provided evidence of upgrading by frontline officers in order for specific cases to receive an

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intervention, and downgrading by specialist units in order to manage caseloads and/ or ration scarce intervention resources (Myhill et al., 2023). A handful of studies have evidenced a relationship between primary risk assessment, risk management interventions, and further reports to police. Belfrage et al. (2012) reported on the implementation of the SARA in Sweden. They found a high level of predictive validity between risk grading on the SARA and risk management recommendations made by police, and that high levels of intervention resulted in reduced recidivism in cases graded as high risk. Contrary to this, Svalin et al. (2018) reported in another Swedish study that “protective actions had been implemented in only 23% of all cases and no association was found between protective actions and repeat IPV violence” (p.  77). In the United States, Messing et  al. (2014) found, using baseline and follow-up interviews with victims, that those identified as high risk by an 11 question “lethality screen” administered by first responders were more likely to seek support from specialist services and take protective actions. Most recently, Hester et al. (2019) reported findings relating to victims referred to support services in England and Wales after having their case heard at MARAC and for which the perpetrator was subject also to intensive offender management. Victims reported to specialist support workers significant decreases in physical and sexual violence, as well as less controlling and coercive behavior. Finally, Sechrist and Weil (2018) reported on the positive results of a focused deterrence initiative with domestic violence perpetrators identified as high risk. Unfortunately, the research designs used in these studies are adequate to identify potential or promise, but inadequate to make persuasive causal inference. It is surely a common place to end an academic review with a call for further research, but in this context there is no other way one could conclude for we need a stronger research base on implementation fidelity of risk-led policing, and to understand better what particular component or combination of components are more effective to improve outcomes in this domain.

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Chapter 12

Police and Court Interventions for Family Violence James McGuire

The principal objective of this chapter is to review evidence and summarize what is known about the effectiveness of police and court actions on the future probability of family violence of several kinds. While the majority of people may feel safest when with close family members, sadly for a significant proportion of us, our families, although supportive in some respects, may be dangerous and damaging in others. Harmful behavior within families takes several forms, such as intimate partner violence (IPV), victimization of children, and abuse of vulnerable relatives, including elders. The spectrum of problems and their interrelationships are mapped out by Southern and Sullivan (2021) and many show evidence of being intergenerational. The main focus in what follows is on the nature and evaluation of interventions: What can be done to reduce these problems? Throughout the chapter, therefore, emphasis is placed on empirical evidence concerning the effectiveness of interventions, and on systematic reviews of primary research studies. A related aim is to provide practitioners and service managers with guidelines for best practice in remedying these problems. Such problems present significant challenges, and to date no solution has been found than can reliably and satisfactory resolve them. Nevertheless, positive steps can be taken, and some courses of action offer more promising directions for progress than others. The ground we will cover focuses specifically on what can be accomplished through the actions of police and by means of court-based decisions, and legal orders and processes. This chapter does not review the extensive research on therapeutic or other psychosocial work with perpetrators of family violence or of spousal, child, or elder abuse, for example using batterer intervention programs (BIPS, or batterer intervention and prevention programs) and other treatment or recovery options; or research on reduction of violent or sexual offending or child J. McGuire (*) University of Liverpool, Liverpool, UK e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 P. Sturmey (ed.), Violence in Families, Advances in Preventing and Treating Violence and Aggression, https://doi.org/10.1007/978-3-031-31549-7_12

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molestation; or on trauma-focused work with victims. Implementation of those types of intervention usually occurs at later stages of the criminal justice or penal process, in prison or mental health services or under probation supervision. However, initiatives have been taken to make them more readily available at earlier points, and participation in them can be facilitated or even directly authorized by police and courts. Clearly the first and extremely important contribution that police and courts make to the problem of family violence, as with other breaches of criminal law, is via the customary activities of detection, investigation, arrest, prosecution, and sentencing of those who are found to have perpetrated such abuses. This takes us to what is usually regarded as the prime function of law, and to the role of the principles of retribution, incapacitation, and deterrence in controlling criminal and other antisocial behavior, thereby protecting citizens from harm. Those core features of criminal justice processing are today, however, known to be limited in what they can achieve. In addition, it is also known that they can have detrimental effects: There are instances in which imprisonment of an abusive parent, or removal of a victim from a family home, can compound existing difficulties and generate problems of other kinds. Many attempts have been made to find more creative solutions to these challenges that can enable families who wish to do so to stay together, while addressing the harmful behavior that has occurred. While this change cannot be dated precisely, until approximately the 1970s violence within families was typically seen as a private matter, and unless it took a blatantly serious form, police were reluctant to become involved. The prevalence rates of intrafamilial abuse, including IPV, or of violence against children or elders, were all unknown. They were not recorded separately in criminal statistics and were scarcely researched, as to a large extent they were taken for granted, in a sense unofficially permitted. Even today, published crime statistics do not usually differentiate between violence committed inside and outside families. In the past it was commonly accepted, and it continues to be in many places, that children needed chastisement, and physical discipline was widely condoned even in schools. It was widely believed that husbands had a right to control their wives, and that there could be no such thing as rape in marriage. The growing recognition that such abuses were very frequent and caused considerable harm, and the view that they constitute violations and should not be tolerated, are developments of approximately the last 50 years. In some parts of the world; however, these ideas have still not become implanted within shared systems of public attitude. For ease of coverage what follows is divided into two main sections, looking at interventions carried out by police and courts, respectively. This is based mainly on where key decisions are made and changes initiated, but in practice many attempts to address family violence are the product of joint effort and decision-making, not just by police or courts but by many agencies working cooperatively and interdependently.

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1 Policing What kinds of actions do police take in response to the problem of domestic abuse (DA) or IPV and how effective are they? To answer these questions McGuire et al. (2021) conducted a review of research. We searched nine electronic databases: PsycINFO (Embase), the National Criminal Justice Reference Service (NCJRS, Washington DC), Web of Science, Scopus, Criminal Justice Abstracts, Psychology and Behavioral Sciences Collection (EBSCO), Australian Institute of Criminology, Swedish National Council for Crime Prevention (Brå, Stockholm), and the Netherlands Institute for the Study of Criminality and Law Enforcement (NISCALE, Leiden University). Initial searches were later updated, though in a less extensive way, to December 2021. A number of inclusion and exclusion criteria were applied with respect to publication status, language of origin and other factors. Police initiatives in the effort to address IPV take a number of forms and there is evaluative research published in relation to each of them. The research studies that were identified showed that police interventions could be divided into four major categories as follows. (1) Arrest. The use of arrest, usually of alleged perpetrators of violence but sometimes of both partners in a couple, and the experimental study of this can probably be credited with instigating the contemporary era of greater police attention to family violence. (2) Domestic violence response units. Here, a section of a police department is created to specialize in responding to and managing these problems. Part of this sometimes involves second responders, who visit a family at some point after the initial response. In other cases, it involves a variety of professionals bringing a broad array of skills to incident management. (3) Coordinated community-based response. This refers to a set of approaches in which a range of services, including preventive work, is provided to families; the exact configuration varies across locations, according to assessed patterns of need and profiles of agencies. (4) Women’s police stations. Police stations staffed largely or exclusively with female officers have been established for some years in several countries of the global south.

Previous Reviews The searches outlined here found six published systematic or meta-analytic reviews of evaluation research on policing of family violence, listed in Table 12.1. This is a very complex area to investigate and while it has sometimes been done, the use of high-quality research designs is not easy to implement. The main conclusion that emerges from the reviews is that to date, there is not yet sufficient convincing evidence on any single police-based response to family violence to allow confident statements to be made, or to justify definitive recommendations on the best course of action to follow. Nevertheless, there are some indications of possible routes towards improved results.

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Table 12.1  Previous reviews of outcomes of police-led responses to family violence Number of studies 10

Review Davis et al. (2008), note also Davis et al. (2021)

Focus Effects of second responder programs

Dowling et al. (2018)

346 Wide-ranging review of the effects of policing on different aspects of domestic violence

Compares crime Garner and control effects of Maxwell sanctions (2011), Maxwell and Garner (2012)

31

Maxwell et al. (2002)

Pooled data from 5 the Spousal Assault Replication Program (SARP) studies

Mazerolle et al. (2019)

Reviewed a variety of police strategies for action on DV

193 including 26 evaluation studies

Findings Evaluated programs in which a police officer or a victim advocate make a follow-up contact after the initial police response. Found a small increase in reporting of second incidents but no effect on reports of new abuse incidents. An updated review is currently in progress Extensive review of several aspects of police responses to domestic violence. Authors searched 10 databases up to 2016 and grouped records into six areas: (a) the impact of workforce development, notably practice-­ oriented training; (b) interventions to increase rates of reporting IPV; (c) the effects of first response, including arrest; (d) preventing IPV repetition; (e) factors influencing investigative outcomes; (f) police decisions to lay charges Compared the effects of prosecution, conviction and of severity of penalties on repeat offending in IPV. Conducted 143 tests within the obtained studies. Findings were diverse and inconsistent and no clear pattern emerged, but the dominant finding was one of “no effect” (p.489). This was thought possibly due to lack of statistical power, selection biases and missing data Analyzed 4032 incidents of spousal assault across 5 sites. Multivariate analysis indicated modest, but consistent reductions in subsequent prevalence of new victimizations. Depending on the outcome variable measured, this ranged from 4% (official arrest data) to 30% (victim report data) Concluded that “there is little recent evidence to support the efficacy of mandatory arrest policies” and they may even produce “backfire effects” (pp.18–19). The only positive results were on willingness of victims to inform police of breaches of non-contact orders; and impact on arrest rates of body-worn cameras, specialized domestic violence units, and conditional cautioning. Other methods were ineffective (continued)

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Table 12.1 (continued) Review Shorey et al. (2014)

Number of Focus studies 13 Coordinated community response (CCR) for victims of IPV

Findings Narrative review of studies of the effectiveness of multi-agency integrated responses to IPV with an emphasis on results for victims. Places more emphasis on the components of CCR than on its outcomes but does report some results for advocacy, criminal justice, counselling and healthcare services. Found positive results on emotional state, self-esteem, coping, social support and other factors for advocacy and counselling. However, some results showed no between-group differences and a lack of clarity on which CCR components generated changes. Findings for criminal justice and healthcare-led services were more equivocal

Arrest of Individuals or Couples The importance attached to the arrest of alleged perpetrators of domestic abuse, especially of partner violence, was given a major impetus by a seminal study published in the 1980s, the Minneapolis Domestic Violence Experiment (MDVE; Sherman & Berk, 1984). Traditionally, the police had been reluctant to make arrests for non-lethal domestic violence, unless victims demanded they do so or the situation otherwise became difficult to manage. They occasionally became involved in dispute resolution, or asked one of the parties to leave the scene for a short period. In a formal experimental arrangement, three different interventions were compared with each other. They were arrest of the alleged perpetrator; provision of advice to the couple; or temporarily separating the couple. Over a period of approximately 18  months, 330 cases were randomly allocated to one of these three conditions. Arrest resulted in a statistically significant reduction in recurrences of domestic violence as compared to the other two interventions. The MDVE had considerable research and public impact and over ensuing years a number of US cities and states implemented arrest practices. There was also a series of five trials, the Spousal Assault Replication Program (SARP), conducted in other sites to test the reliability of the finding. This produced what at first appeared to be an inconsistent set of results, although some of the replication studies were not very faithful reproductions of the original MDVE program. At a later stage however, data from several evaluations of the SARP experiments were combined in integrative reviews (Garner et al., 1995; Garner & Maxwell, 2000; Sugarman & Boney-­ McCoy, 2000). Using multivariate analysis, Maxwell et  al. (2002) showed that when the roles of other variables were excluded, there was evidence of some effect of arrest on reducing IPV recidivism. However, the perpetrator’s prior arrest record was a stronger predictor of the outcome, and in most cases, there was a decline in

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the number of assaults committed over time that was independent of external influences. Despite these complexities research continued on the role of arrest as a potentially effective intervention for reducing IPV. The studies located by McGuire et  al. (2021) showed different directions of effects. Based on a re-analysis of the SARP projects, Siddique (2013) suggested the effectiveness of arrest has been under-estimated in the past, including in the MDVE. Cho and Wilke (2010) found a large effect of arrest on reducing IPV by men, and Gerstenberger and Williams (2012) found a sizeable effect for dual arrest (of both members of a couple). However, given the preponderance of male perpetrators, the latter has resulted in inappropriate detention of many women. A study of police forces in north-east England found that women were arrested to a disproportionate degree given the smaller number of incidents in which they were perpetrators (Hester, 2013). Besides that, however, a larger number of studies found no detectable effect of arrest (Davis et al., 2001; Dichter & Gelles, 2012; Felson et al., 2005; Hilton et al., 2007; Hirschel, 2008; Mears et  al., 2001). One study suggested that  short-term effects might be misleading about probable longer-term outcomes (Klein & Tobin, 2008). Two studies indicated there may be differential effects according to the pattern of an individual’s violence history and other kinds of offending (Johnson & Goodlin-Fahncke, 2015; Piquero et al., 2006). The review by Dowling et al. (2018) located 137 studies with a bearing on arrest; however, they noted that “the most common research design was the inferential analysis of relationships between variables” (p.113). There were 86 studies of this type, comprising 61% of all those located, whereas only 13% (19 studies) were studies that permitted evaluation of outcomes. These were either researcher-­ manipulated, involving experimental or quasi-experimental designs, or naturally-­ occurring before-and-after or between-group comparisons. There is initially favorable evidence that arrest affects several stages of the ensuing process if officers are supplied with body-worn cameras. Morrow et  al. (2016) compared IPV cases in two police squad areas in Phoenix, Arizona, before and after introduction of such cameras in one of the areas. Incidents where bodyworn cameras were used were significantly more likely to result in an arrest (40.9 vs. 34.3%), to have charges filed (37.7 vs. 26%), for cases to be furthered (12.7 vs. 6.2%), for there to be a guilty plea (4.4 vs. 1.2%) and for there to be a guilty verdict in court (4.4 vs. 0.9%). In a study in the Metropolitan Police Service, London, Natarajan (2016) evaluated another technology, that of specialized mobile phones which enabled IPV victims to contact police using a speed dial facility. The study reports demographic profiles of 742 individuals who were issued the handsets, and details seven cases of lifethreatening situations. Use of the phones increased the rate of perpetrator arrest and other benefits including reduced fear and improved quality of life for victims. There is a possibility that the reporting of domestic violence to police, and the sense of power that a victim so gains, can be a more potent influence on reducing its recurrence than arrest in itself (Miller, 2003). Not surprisingly, when perpetrators are arrested, it may not be that event which has an independent effect, but what

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happens afterwards in terms of prosecution, processing and treatment, discussed later in this chapter. On a separate level, there is the worrying implication that arrest may be associated with extremely deleterious after-effects in the longer term, including premature victim death (Sherman & Harris, 2015). Methodologically, some of these studies are not strong and the majority involve only single cohorts, although three involved long-term follow-ups of the SARP experiments, and others made use of large-scale survey data. In other respects, these studies are a fairly diverse mixture in terms of both their specific objectives and research designs. It is difficult to conclude from them that arrest, which at one stage appeared to offer striking prospects of an impact on partner violence, is well supported by the assembled evidence. At the same time, there is a possibility that it may have an effect on a sub-group of those who commit family violence, if it becomes possible to identify that group successfully. Doing so could involve a combination of risk assessment and examination of abuser type. But those would be difficult decisions to make at the scene following a call for assistance unless the perpetrator or partner were already known to the police.

 omestic Violence Units and Coordinated Response Between D Police and Other Agencies A second type of intervention widely used is that of coordinated responses involving varying levels of contribution from different agencies. In some instances, this is initiated and led by police departments, while in others it entails joint, collaborative action, for example, through integrated, multi-professional teams. Evaluation studies in this area have focused on an assortment of interventions, which despite having some features in common also differ in important ways. Most can be grouped into one of four main categories: (1) the introduction of specialist domestic violence response teams or units (DVUs) in police services; (2) second responder schemes, in which following a first response to a call for assistance, a second visit is made to the couple after a specified interval; (3) Domestic Violence Home Visit Intervention, involving joint home visit procedures by police and another agency; and (4) coordinated community response (CCR), a broader form of public awareness or education campaign. As found with research on arrest, no definitive pattern of results emerges from these studies; however, some trends emerge in support of the use of the first of the above options. DVUs deal with more serious cases, though perhaps with the result that prosecutions can be more difficult to obtain, because they require higher grades of evidence (Friday et al., 2006). When introduced in pilot form DVUs were perceived positively by patrol officers (Corcoran et  al., 2001), and there is tentative evidence that they can lead to significant reductions in recidivism (Exum et  al., 2014; Friday et  al., 2006; Whetstone, 2001). The study by Exum et  al. (2014) yielded the largest effect in support of a specialized police DVU.  The one they

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evaluated, in Charlotte, North Carolina, consisted of a sergeant, four detectives, an administrative assistant, four counsellors, and a group of citizen volunteers. The unit pursued intensive investigation of family violence cases, undertook preparation of materials for court, in combination with provision of victim assistance. Domestic violence (DV) unit cases had a recidivism rate of 29% compared with one of 37% for cases subject to standard patrol or routine handling over an 18–30 month follow­up period. Similarly encouraging results emerged from a randomized controlled trial (RCT) by Hester et al. (2019) of the Drive program in the UK, an intervention focused on high-risk, high-harm IPV perpetrators. Participants were identified through multi-­ agency conferences that included police, probation, health, child protection, housing practitioners, independent advisors, and other specialists from the statutory and voluntary sectors. The authors prepared a coordinated response to ensure the safety of those at risk of harm. Between intake and closure of cases, among Drive participants there was a statistically significant reduction in scores on several risk indicators. The intervention had positive outcomes with similar patterns observed at both research sites. For individuals identified as serial IPV perpetrators, the mean number of police-recorded incidents among Drive participants at 12-month follow-up was 1.5, whereas the corresponding figure for the control group was 7.5. Second responder procedures show markedly disparate outcomes. A study by Davis et al. (2010) found that the time-lapse between first and second police visits, whether 24 hours, seven days, or if there was none, made no difference to the number of subsequent abuse incidents. They concluded that these forms of intervention “are at best ineffective and at worst may place victims in greater harm” (Davis et al., 2010, p.415). However, a study by Scott et  al. (2015) found very encouraging effects. The intervention in this case was informed by the risk-need-responsivity (RNR) model of offender rehabilitation, discussed later in this chapter. Rates of new DV charges over a two-year follow-up were 12.2% in the intervention group as against 41.5% in the comparison group. The Domestic Violence Home Visit Intervention involves specialist training for outreach police officers who are paired with victim support advocates, who in a follow-up visit, can then together facilitate access to a wide range of services. In a series of studies, Stover and her colleagues (Stover, 2012; Stover et al., 2008, 2009, 2010) reported evaluations of different aspects of these arrangements, including development of a safety plan for each victim. They found this enhanced engagement with police, and led to improved relationships with them. One result was more reporting of subsequent abusive incidents. Others included greater likelihood to resort to court-based services, and to seek and maintain mental health support for children. However, findings on other effects including DV recidivism and its severity were non-significant. It is difficult to draw overall conclusions regarding other types of intervention. Police- community partnerships can take numerous forms (Reuland et al., undated), but results on the effects of them are somewhat ambiguous. One RCT found some positive outcomes, influencing the seriousness but not the prevalence of IPV (Goosey et al., 2017); another obtained positive but also some unexpected adverse

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effects, in the form of more arrests of women victims (Salazar et al., 2007); while others reported no effect (Hatcher et al., 2020; Muftić & Bouffard, 2007; Post et al., 2009). Some of the inconclusive results may have been due to plans having been poorly implemented, because of inadequate agency support. Better findings were obtained in a well-designed study by Strang et al. (2017) in which males arrested for domestic violence in Hampshire, England, were randomly assigned to being granted a conditional caution if they agreed to and did attend a two-day Cautioning and Relationship Abuse preventive program. Over a one-year follow-up, members of the groups had a 27% lower harm score, and a re-arrest rate 21% lower and prevalence rate 35% lower than controls. The standardized mean difference effect size for DV recidivism was −0.299. Note however that for participants in the study, this was their first DV offence. Also, in common with research on arrest, while there are exceptions (Goosey et al., 2017; Strang et al., 2017), the designs used in these evaluations are for the most part not very rigorous. Some were process evaluations only, and among the outcome studies only two employed random allocation. While other studies were fairly well designed given the constraints they operated under, prior differences between groups (selection bias) detracted from the chances of being able to draw conclusions with confidence. In addition, the statistical models developed in these studies accounted for only rather small proportions of the variance in results. In other words, there are probably many other factors influencing results which studies have not recorded. While this remains a speculation, the most likely explanation of such a pattern is that a large number of factors each explains a small amount of the variation in results. Bates and Douglas (2020) provided an overview of the range of services available for victims of domestic violence in the United States and the United Kingdom, showing the extensive variety of types of provision and the gaps that persist in the support networks and in their connectivity. They made a series of recommendations for improving the position with reference to legislation, levels of resources, and training, among other areas. Where agencies work together, close attention needs to be paid to establishing a core set of expectations about their goals (Slaght & Hamilton, 2005). But the involvement of police in multi-agency responses to IPV has continued to show wide variation in practices from one location to another.

Women’s Police Stations and Justice Centres Another set of studies has reported on the effects of a change that offers some of the most promising results to have appeared to date. This is the establishment of police stations staffed entirely or almost entirely by women officers. While this may sound like a novel idea of recent origin, such stations have existed in India and in some parts of Latin America for several decades. Different documents date the opening of the first such stations to Kerala, India in 1973; São Paulo, Brazil in 1985; La Plata, Argentina in 1988; and Tamil Nadu, India in 1992. By 2010 there were over 500

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such stations in Brazil, and the model had been adopted in 14 mostly low- or middle-­ income countries (Perova & Reynolds, 2017). In Argentina the stations have a multidisciplinary staff team, including social workers, lawyers, and psychologists, working alongside police. Services of this nature are based on a model of empowering female victims of male violence, challenging patriarchal norms, and facilitating women’s access to justice, while also creating a career pathway for more women in law enforcement. Implemented in this manner, they thus reach much farther across the spectrum of variables thought to affect violence against women. This development has led to several kinds of positive outcomes, though the number of available studies is small, and once again the research designs limit the strength of the conclusions that we can draw. Evaluation studies often use large-scale official crime statistics rather than experimental trial designs. There have been increases in the rates of reporting of violence against women in India (Amaral et al., 2019), and reductions at statistically significant levels in rates of violence against women in Argentina, Brazil, and Peru, in each of which women police stations provide access to a range of services relevant to responding to IPV (Kavanaugh et al., 2017). Carrington et al. (2020) have attributed a marked decrease in femicide in Buenos Aires to the operation of these stations, and recommended that similar services be adopted elsewhere. We can view this innovation against a background in which to date, the influence of women officers on policing has been fairly limited. Prenzler and Sinclair (2013) collected data on the proportions of female officers in police services from English language websites in 14 countries for the ten years prior to July 2012. There was a considerable range from the highest figure of women officers of 28.8% in the Australian state of Tasmania to the lowest at 5.1% in India. But there was also evidence of a plateau effect, with increases slowing over later years. Complementing this, Miller and Segal (2019) analyzed several aspects of policing in the United States over the period from the late 1970s till the early 1990s as the proportions of women officers in the police workforce steadily grew, from 3.4 to 10.1%.They found that an increase in the female officer share of the workforce was associated with increasing rates of reporting of domestic violence to police, and more effective responses by police to reports of sexual assault. However, investigating the effects of Women’s Police Stations in the Indian state of Haryana, Jassal (2020) sounded some cautionary notes. It is important for such stations not to develop into enclaves offering an exclusive service, as this results in deflection of workloads from one station to another, and negative perceptions of women officers.

Summary In conclusion, against the background of a highly influential MDVE research project, numerous other studies were conducted to evaluate the possible impact of arrest in reducing DA/IPV. Some of these did show beneficial results. However, research carried out over the last 15  years suggests that other than in situations

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where officers judge it as necessary, there is little convincing evidence that arrest in itself is an effective action to employ as a routine practice in deterring DA/IPV. Results of research on its effects are mixed. Some authors have questioned more generally whether deterrence policies are likely to have much success with this problem (Sloan et  al., 2013). On the other hand, there is tentative evidence that victims reporting to police may be effective, and that processes which increase actual or potential victims’ confidence in police and empower them in making contact may also increase their willingness to report assaults. There is also provisional evidence that arrest of some suspected IPV perpetrators may have an impact in reducing subsequent repeat offending, as a function of risk levels and previous patterns of DA and other types of offending. This raises the prospect of attempting to identify those factors and test the feasibility of such action. However, this may not be applicable to new calls for assistance, but only to second and subsequent calls. The strongest evidence regarding other initiatives supports first the use of specialized police DVUs that include a mixture of personnel. Although the total volume of work on this remains limited, findings suggest they are perceived positively by victims and can have a significant impact in reducing repeat DA/IPV offending. The roles of the specialized DVUs that have been found to be effective include a combination of more intensive investigation, provision of victim support, and preparation of case material to improve possibilities of successful prosecution. Second, mainly positive outcomes are associated with the establishment of police stations staffed largely, if not completely, by women officers. There are different models of implementing this with the most favorable being one where other professional groups work alongside police. But the number of studies is rather small. Among the conclusions reached by Dowling et al. (2018) in their wide-ranging review of research on policing and IPV was one to the effect that “it is wrong to assume that mandating an increase in the use of a particular police response (e.g., pro-arrest and pro-charge policies) will inevitably have desirable flow-on effects on subsequent police and criminal justice activities” (p.76). That is, almost any method the police can employ has varying effects dependent on different types of cases.

2 Courts It has been widely recognized for some time that violence within families raises issues that differ in important ways from violence that occurs in other contexts. For example, an assault on a victim by a stranger does not possess the relational complexity found within families, where despite the presence of aggression there may also be patterns of attachment, co-dependence, and other dimensions, requiring an approach that entails considering several issues other than or in addition to the arrest, prosecution, trial, and sentencing of the perpetrator. Official reactions are of course influenced by the severity and frequency of the offenses committed, and in many instances removal of the offender from the family is the only realistic option,

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either through the imposition of a prison sentence or the use of a domestic violence protection order (Agnew-Brune et al., 2017). The dynamics of the situation, however, are such that in some circumstances, criminal justice processes may compound and intensify the negative experiences of family members, and worsen the ordeal of victims. Investment in the singular purpose of prosecuting the offender neglects and can even exacerbate other problems. The aim of criminal justice is to prevent harm, not to cause it. Regrettably there are many circumstances in which it fails in this endeavor. With mounting appreciation that exclusive reliance on the predominant punitive ethos of criminal sanctioning is not always appropriate and in some circumstances is plainly counterproductive, a range of provision has evolved in response to intricacies of these kinds. The most widely disseminated shape this has taken followed the emergence in the 1980s of problem-solving courts, which developed into several discrete formats concerned with different types of problem. Since their inception there has been a general trend toward gradually increasing specialization in these courts. Thus, there are specialist drug courts, mental health courts, youth courts, and re-entry courts (Wiener & Brank, 2013) and many other varieties. Moreover, their existence appears to enjoy majority public support (Thielo et al., 2019). The variant of interest here is DV courts, the first of which were established in the United States in the 1980s and early 1990s. The impetus for their subsequent expansion was the passing of the federal Violence Against Women Act in 1994. Ten years later there were at least 160 such courts across the United States (Keilitz, 2004), and within a few more years the number had expanded further to 208 (Labriola et al., 2009). The idea of problem-solving courts has been adapted and implemented in several other countries (Holder, 2020), though information concerning this comes mainly from Canada (Crocker & Crocker, 2017), Australia (Schaefer & Beriman, 2019), and China (Li & Liu, 2019). Note, however, that in the opinion survey conducted by Thielo et al. (2019), although they were viewed favorably on average, DV courts received lower ratings of support than other types of problem-solving specializations. The exact mode of operation of DV courts varies with respect to the jurisdiction in which they are based. The essential common feature is a calendar of dates on which family violence cases will be heard, with official court oversight of the resultant actions and processes that ensue. Given the growth in the number of courts designated as serving this role, there has been an expanding number of dedicated personnel with extensive experience of the issues. The systems thus developed usually afford access to advocacy and other legal and support facilities. They often require perpetrators to attend treatment programs, and entail judicial or probation-­ based monitoring of case progress. Like family courts, DV courts may also address the welfare of dependent children (dependency court) and make decisions on child protection issues. Initially there were uncertainties over how many features a court service should possess before it could properly be called a DV court (Karan et al., 1999). In a fully developed integrated systems model, the judge addresses all aspects of a family’s problems linked to violence, encompassing both criminal and civil matters, and

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covering related family issues such as child welfare, thus having “both criminal and family proceedings resolved in a single court” (Birnbaum et  al., 2017, p.622), a practice sometimes captured in the phrase “one case, one judge.” Ideally several elements will be present, including among others effective procedures before and after arrest, comprehensive victim advocacy, multi-agency collaboration, integrated case processing, use of successful interventions, systematic data collection and distribution, and processes of monitoring and judicial overview (Karan et al., 1999; Mazur & Aldrich, 2003). The DV court is thus the center of a network of allied professionals, which alongside the judge and other legal personnel will include police, victim advocates, probation staff, and representatives of community provider agencies, among others. Depending on the balance of these ingredients, there can be significant differences of emphasis between courts, with some placing offender rehabilitation and accountability as central to their objectives. But the majority give most priority to the safety and welfare of victims. Those are not incompatible objectives; but the relative weight given to each has a decisive impact on the procedures followed and the services provided, and some observers repudiated the notion that DV courts could play a core role of rehabilitation (Mazur & Aldrich, 2003). Stated objectives naturally carry differing implications for how processes and outcomes will be evaluated, crucially affecting performance measurement. On that basis Porter et  al. (2010) distinguished several parameters of court operation and proposed different indicators for DV courts, depending on their dominant ethos. In a key overview of the evolution of DV courts, Gover et al. (2021) trace their more distant origins to the women’s rights movement of the 1970s. As more victims’ voices were heard and their accounts were understood, there was an accelerating public and policy awareness of violence in the home. Survey data increasingly exposed the far higher prevalence of IPV and other family violence as compared to what had previously been assumed. There are grounds for suggesting that these are the commonest types of criminal events, exceeding the quantity of what were traditionally labelled “volume crimes” such as theft and other acquisitive or property offenses (Garside, 2006). There is agreement that in a manner similar to drug courts, which were the prototype for other forms of problem-solving court, DV courts generally shifted the principal focus of attention from a punitive to a more therapeutic orientation (Coulter et al., 2005). Nevertheless, some observers have considered that DV courts differed substantially from problem-solving courts (Mazur & Aldrich, 2003). Others have suggested that the original drug court model has had an enduring influence on both DV and other problem-solving court specializations (Kaiser & Rhodes, 2019). These contrasting views may be reconcilable when we realize that the advent and diversification of problem-solving courts have often been driven more by fundamentally pragmatic considerations than by any clear formulation of purposes and methods (Boldt, 2014). Additionally, as Thielo et al. (2019) have commented, “all types of problem-solving courts have been put into place prior to evidence demonstrating their effectiveness” (,p.271). However, aspects of this were refined conceptually and became more fully articulated through the application of therapeutic

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jurisprudence, a model concerned with the sometimes-alienating complexion of legal procedures, analyzing how decisions made by lawyers and judges affect all those involved in them (Rottman & Casey, 1999; Winick, 2000, 2013). There can be numerous variations in the precise powers DV courts exercise, in how they function, and in the configuration of services they assemble for assessment, support and management of cases. They may engage in pre-court conferences to examine cases prior to the entry of pleas (Tutty & Koshan, 2013) and can arrange the recruitment of court-appointed advocates (Gershun & Terrebonne, 2018). They may mandate attendance by convicted offenders at specially designed therapeutic programs (e.g., BIPs) delivered by affiliated community agencies (Porter et  al., 2010). They may impose monthly judicial monitoring, though the value of this as a separate component appears to be no more than marginal (Rempel et  al., 2008); alternatively, they may authorize attendance at probation-based programs (McCanna, 1999). In this connection proposals have been made for the adoption of a standardized, comprehensive approach to perpetrator assessment (Sonkin & Liebert, 2003). The existence of a DV court is likely to necessitate changes of practice in other agencies working in conjunction with it (Eley, 2005).

Previous Reviews There have been several kinds of research and analysis conducted on aspects of how DV courts operate. They include studies on the legal and ethical issues raised by variations in practice (Rosenbaum et al., 2003), process evaluations of the perceptions of different stakeholders (Cissner, 2005; Coulter et  al., 2005; Gover et  al., 2007), and analyses of how DV courts reach decisions (Pinchevsky, 2017a). Our principal focus here, however, is on whether there is evidence that DV courts are effective in successfully delivering their intended objectives. For victims those pertain to their reported satisfaction in terms of speed of case processing, their ability to access much-needed services, and whether vital benefits are secured with respect to their safety and wellbeing. Conversely for perpetrators of family violence, the principal recorded outcome is whether they commit further acts of that kind. For families, a key outcome may be whether they separate, remain together, or can be safely reunited after a period of partition. These and other indicators of change have been evaluated in research studies. To address such questions of effectiveness several databases were searched, including Scopus, PsycINFO, the Cochrane Database of Systematic Reviews, the website of the Campbell Collaboration, and the National Criminal Justice Reference Service (NCJRS). The evidence gathered shows a mixture of results, with many studies showing positive effects, but others only limited changes, and some none at all. However, enough has been learnt to suggest that some particular combinations of the various components are more likely than others to produce beneficial results. Systematic and integrative reviews are indispensable for this purpose and searches found five relevant publications of this kind, listed in Table 12.2. While

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some positive outcomes emerge from them, the overall picture from these appears rather incongruent and not very encouraging. In what follows, I consider patterns of variations within the existing reviews and several studies not subsumed in them. This makes it possible to identify combinations of factors linked to better outcomes, pivotal if we seek to formulate reasonable practical advice. As shown in Table  12.2, Gutierrez et  al. (2016) located 20 studies published between 1996 and 2013, 6 from Canada and 14 from the United States. The majority Table 12.2  Reviews of research on court-based interventions Number of studies 20 (with 26 unique samples)

Review Gutierrez et al. (2016)

Focus Meta-analysis of the effectiveness of domestic violence courts

Miller et al. (2013)

Meta-analysis of IPV intervention studies

Wilson et al. (2021)

Court-mandated interventions for IPV

Zeoli et al. (2016)

Studies of legal 4 interventions to reduce firearm possession by IPV perpetrators

Zhang et al. (2019)

Effects of Family Treatment Drug Courts

Located 5 on courts and legal measures

17

Findings Aggregate sample size of 26,601 offenders (14,279 from DV courts and 12,322 in comparison groups). Found an overall positive effect size for individuals managed by DV courts as compared with others subject to traditional court processes, with a mean odds ratio of 0.81 for both general and DV recidivism. When analysis narrowed to include only the better quality studies in terms of research design, the between-group difference disappeared Reviewed a range of interventions designed to reduce DV recidivism, found 2 on DV courts, and 1 each on probation supervision, judicial, and GPS monitoring. Results showed mixed impacts for courts and probation, and small effects for judicial and GPS monitoring Cumulative sample size 4824. Only RCT or rigorous quasi-experimental studies were included. Mean effect size showed a modest drop in official reports of IPV recurrence, with an odds ratio of 0.79 for experimental and of 0.54 for quasi-experimental studies. However, neither of these figures was statistically significant. For victim-reported outcomes, no difference was observed Review of research on the risk of fatality where firearms are present in IPV; partly focused on interventions. Legal statutes to prohibit purchase of firearms by those under DV restraining orders (DVROs) reduced the risk of lethality in three studies; a fourth study showed reduction in nonfatal IPV Studies focused on levels of success in bringing about family reunification, and effects on children’s safety and welfare. There was an impressive odds ratio effect size of 1.75 on child welfare outcomes. The odds ratio for recurrence of maltreatment was 0.50 which shows an average reduction but this was not statistically significant

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of these studies (15/20) were not at that point published in peer-reviewed journals. There was substantial heterogeneity among the findings, associated partly with weaker effects among participants assessed as posing higher levels of risk, and partly with the quality of research studies, with more rigorous designs not showing any positive outcomes. But within the analyses, there was a marginally discernible trend related to systems of service guided by the risk-needs-responsivity (RNR) model, along the lines specified by Andrews and Bonta (2010) and Bonta and Andrews (2016). Only a few of the programs showed any adherence to RNR principles, but the ones that did yielded significantly superior outcomes to the majority which did not. Stewart et al. (2014) had previously reported a similar finding with regard to the advantages obtained from adherence to the RNR model in engendering change in DV perpetrators. A closely connected issue is that of the effectiveness of treatment programs when attendance at them has been stipulated by courts. A review of court-mandated BIPs was undertaken by Wilson et  al. (2021), as an update and extension of previous reviews of the same area (Feder & Wilson, 2005; Feder et al., 2008). The authors concluded that the findings were equivocal, in that while they found no evidence that the programs had negative effects, there was no real evidence of positive effects, casting doubt on the value of court-mandated BIPs. Concerning effects on other victims within families, Zhang et al. (2019) reported a meta-analytic review of outcome research on the effects of Family Treatment Drug Courts. These have a specific remit to address parental substance abuse problems that are contributing to conflict within families and to maltreatment of children. As shown in Table  12.2 this meta-analysis reported a strong average effect on child well-being indicators. Zhang et al.’s review aligns with others showing the positive impact of drug courts on some variables. There is a fairly firm consensus on this point, underlined in a review by Marlowe et al. (2016), which found that substance-­ abusing individuals were considerably more likely to graduate from programs than those on probation or on other substance abuse programs. This has implications for DV court practices, as alcohol or other substance abuse is associated with many occurrences of violence within families. There have been separate reviews of adjacent issues with a close bearing on how to respond to family violence. Latzman et  al. (2019) reported a review of eight RCTs on the well-being of children exposed to IPV. While less directly pertinent to the evaluation of DV courts as such, this review indicates the importance of pursuing goals where the interests of children are placed centrally in decision making and service provision.

Findings of Specific Primary Studies Initial evaluations of DV courts were not especially reassuring. One of the earliest reported concerned an experiment in Broward County, Florida, in which a sample of 404 male DV offenders was randomly assigned to either probation, or probation

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plus participation in a 26-week counselling program designed to reduce partner abuse (Feder & Dugan, 2004). This was conducted over a five-month period in 1997, with a one-year follow-up. Using well-validated scales, data were collected on aspects of men’s attitudes towards women and on their use of different forms of coercion in close relationships, on victims’ reports of further violent incidents, and on police and probation records of further assaults. However, the results showed “no clear and demonstrable effects of counselling on offenders’ attitudes, beliefs and behaviors” (pp. III-14-11). We might anticipate that legally required interventions would secure more reliable and possibly larger reductions in problem behavior as there is more at stake for individuals made subject to such requirements. The Broward study, however, suggested that whether or not such effects occur is more influenced by prior features of individuals, notably their stake in conformity—such as being married, having a steady job, or owning a home—which was correlated with both level of treatment participation and desistance from offending. Individuals’ non-compliance with a court order was predictive of rearrest. In terms of whether victims perceive any palpable benefits of DV courts, other studies too found little meaningful change was reported (Coulter et  al., 2005). Researchers such as Coulter and VandeWeerd (2009) mapped slowly declining DV court referral rates over long-term periods. Some later research suggested that different disposal decisions of DV courts made little difference to eventual outcomes. Pinchevsky (2017b) reported a follow-up study of two specialized DV courts in a south-east American state. Sample sizes of defendants were 1068 and 716, respectively. Among other outcomes Pinchevsky examined were incidence of rearrest and time lapsed till its occurrence. Follow-up analysis with logistic regression showed similar findings from both courts: Fewer than 20% of defendants were re-arrested at three-year follow-up, and the average times to re-arrest where that occurred were 413 and 421 days, respectively. These are lower than the rearrest rates in some other DV court follow-up studies. Nevertheless, there was little evidence that different disposal decisions made by courts had any impact on rates of recidivism, no matter how measured. Yet, where DV courts operate as initially envisaged, there are better outcomes for victims than in traditional courtrooms with respect to what we might call the system-­ oriented side of the picture, in terms of arranging access to multiple services. In line with this, Scott and Kunselman (2007) assembled evidence that DV court services were sometimes not operating efficiently, and expressed skepticism as to how often they worked as intended. For example, in a unified DV court service in Florida, only a 7.5% of defendants were ordered to take part in intervention programs, and despite evidence showing that alcohol or drugs were a factor in one-third of DV cases, the proportion of defendants ordered to enroll in substance abuse counselling was even lower (3.3%). Thus, rates of accessing potentially helpful resources were sometimes disappointing. Scott and Kunselman suggested this had social justice implications, given higher pressures of several kinds within low-income households. There is evidence that outcomes for DV victims are linked to the speed of case processing. Collins et al. (2021) collated evidence that speedier processing times can reduce the likelihood of aggression by suspects before and for some time after

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court proceedings, lower the rate of withdrawal or recantation of evidence by victims, and saves legal costs. In their own study, Collins et al. (2021) found that these factors differed according to whether the processing time was below or above 60 days. Thus, other studies of better functioning courts have found more encouraging results. In a study of DV courts in South Carolina, respondents in a qualitative evaluation reported positive perceptions and high levels of satisfaction (Gover et al., 2007). A parallel quantitative evaluation found that following the introduction of a DV court, there was an initial rise in rates of arrest for DV, and positive results in terms of reduced rates of rearrest in the follow-up period (Gover et  al., 2003). Coulter and VandeWeerd (2009) undertook a multilevel analysis of data on a total cohort of 17,999 individuals arrested for domestic battery in the period 1995–2004 in Hillsborough County, Florida. Based on several characteristics of cases, including severity and chronicity of offending, circuit judges assigned individuals to three levels of intervention. In Level 1, first-time offenders were required to attend a psychoeducational program lasting 8–12  weeks. In Level 2, those with a history of recurrent violence attended a longer program of 26 weeks. In Level 3, those with more complex histories and who showed other features such as weapon use or violation of previous injunctions were assessed more fully and could be assigned to programs lasting up to one year. The rates at which those who completed programs were rearrested compared to those of others who did not were as follows: for Level 1, 8.8% versus 23.4%; for Level 2, 8.3% versus 21.1%; and for Level 3, 8.6% versus 20%. Data for other categories of re-offending showed higher rates, but similar patterns of difference between the levels and when comparing completers to dropouts. This appears to constitute strong evidence of the effectiveness of court decisions linked to corresponding interventions. But there are also limitations within some studies and both here and elsewhere the choice of methodology can make results difficult to interpret. First, the three-level model just outlined makes it difficult to differentiate what are the key elements determining the outcomes—the court process or the treatment program. Second, measured outcomes relied on the accuracy of official rearrest data, which, in the absence of victim reports, may be an underestimate of rates of ongoing family conflict and violence. Still, the general principles of DV courts seem widely supported by professionals, and this is maintained even in the face of only modest outcomes. That can be illustrated from the results of Canada’s first integrated domestic violence court (Birnbaum et al., 2017). Though few outcome variables showed statistical differences in favor of it, the authors considered that the integrated domestic violence court was “a promising alternative to the separate silos approach” of traditional courts and had a “positive impact from a systems perspective” (p.627). Evaluations of Canadian DV courts have been summarized as finding positive outcomes, with reference to both victim-related outcomes and perpetrator rearrest rates (Crocker & Crocker, 2017). While DV courts emerge from some evaluations as being helpful to victims in several ways, results on recidivism have been less consistent; indeed, some studies have found zero effect (Labriola et al., 2008). A major reason for the comparatively

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greater success with victim-related aspects than with perpetrators may be the often-­ high rates of attrition from treatment programs often noted to be in the region of 40 to 60%—with some even higher (Petrucci, 2010). Another may be because some widely used intervention programs are not very effective for the task, but have continued to be used, a point to which we return briefly later. These two factors may of course be interrelated. Another part of the explanation may reside in a pattern whereby people ordered to attend BIPs but who do not comply are dealt with rather leniently, with only a small proportion being given more serious sanctions such as jail time in response (Labriola et al., 2007). Thus, despite the intention of the DV court to make offenders more accountable for their actions, it is not clear that this is regularly fulfilled. At the same time, that may be understandable. Use of jail sentences may be futile given other findings that it is associated with increased rates of rearrest for domestic violence. In a study of factors predicting rearrest for domestic violence within one year of a court hearing, Collins et  al. (2021) found that the strongest factor was being given a jail sentence, which made a new arrest for DV nearly 2.6 times more likely (odds ratio 2.589), followed by having a previous record of domestic violence (odds ratio 2.332). Other very positive results have been reported. Murphy-Geiss et al. (2015) have provided an account of the operation of a DV court in El Paso County, Texas. They described this as a case study as it was a record of what was done in a specific location over a particular period, even though it was a controlled trial of an innovative change involving a sample of 1424 DV defendants randomly assigned to experimental and control conditions. The fundamental change in procedure, in what was designated the Pilot Program, entailed more thorough assessment of defendants, using in-depth interviews, exploration of personal histories, psychological measures, and analysis of substance abuse data. This focus on each defendant’s individuality was a marked departure from the pre-existing “one size fits all” arrangement in which everyone was usually dealt with in the same manner. Results were very encouraging, with experimental participants 3.37 times more likely to comply with court conditions, after controlling for demographic factors (e. g., age, gender and ethnicity), and 41% less likely to recidivate, although the latter effect was partly accounted for by lower rates among females. Several studies have reported lower DV recidivism rates among those who complete programs to which they were referred by courts compared with those who dropped out: for example, 10.6 versus 28.8% at an 18-month follow-up by Hendricks et al. (2006) and 14.3 versus 34.6% at an average 2.4-year follow-up by Bennett et al. (2007). In a study of a California DV court, Petrucci (2010) compared those who completed a 52-week BIP with those who did not. Of 289 DV misdemeanant offenders placed on this by the court, 62% completed the program. At a four-year follow-up, respective rates of DV rearrest for completers and non-completers were 15% and 25%. All these differences are statistically significant. Working on a larger scale, Cissner et al. (2015) conducted a multisite study of 24 DV courts across New York State. There was an initial total arrest sample of 17,718 (divided equally between the DV court sample and comparison group) of whom a total of 7149 received a conviction for a DV offence, of which just under one-fifth

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(18%) were felonies. There was a major improvement in case processing efficiency, with a mean reduction of two months. Three years after receiving a DV conviction, there was a reduction in DV rearrest (29 vs. 32%) which, although small, was statistically significant. A complication of much research is that whether or not DV courts work is often dependent on the effectiveness of the BIP that convicted individuals are required to attend. Perhaps the role of DV court decisions as distinct from attendance at a BIP is demonstrated in a study by Tutty and Babins-Wagner (2016). These researchers compared outcomes for a 30-hour treatment program, Responsible Choices for Men (RCM), before and after the inception of a DV court in Calgary, Alberta. They found a sizeable reduction in DV rearrest from 41.2% in the period before court implementation to 8.2% in the period afterwards. In a later study comparing men mandated to attend the program with others not mandated, both showed indicators of psychological change (Tutty et al., 2020). Inevitably there are differences in how legal processes unfold, principally according to the seriousness of an offense. In the United States, DV courts have been more likely to manage misdemeanor than felony offenses (Labriola et  al., 2007). Successful intervention may be difficult to attain with a proportion of DV offenders, notably those who have a history of family violence, those who are more likely to commit the most serious offenses, or where individuals manifest prior antisocial features including fixed misogynistic beliefs. There are considerable difficulties and obstacles in the way of altering the cluster of attitudes that sustain some aspects of partner violence. A study by Catlett et al. (2010) found that dropout from BIPs was strongly associated with gendered constructions of women, attitudes that may be deeply implanted and rigidly held, due to being almost routinely reinforced by stereotypical messages received from many directions and embedded in many cultures. This may be indicative of the major challenges of implementing DV treatment even when it is court-mandated.

The Contribution of BIPs It is not part of this chapter to review the question of psychosocial treatment effectiveness with IPV perpetrators, and the effects of it are widely regarded as disappointing. Indeed, many would say positive outcomes are marginal at best, and often elusive. Findings from the copious literature in that field are obviously relevant where such treatment is mandated by courts, as it is difficult to separate the relative contributions of each. Given the inconclusive findings of research on the traditional and most widely deployed BIPs (Miller et al., 2013), and the absence of effects from review of court-mandated BIPs (Wilson et al., 2021), perhaps the field of practice could be open to more newly devised approaches, as urged by Aaron and Beaulaurier (2017). First, notwithstanding the prevailing uncertainty and sometimes pessimistic viewpoints, there are more encouraging findings from recent reviews of IPV

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treatment (e. g. Cheng et al., 2021; Karakurt et al., 2019; Travers et al., 2021). As noted earlier one proposal for strengthening intervention includes making more effective use of the RNR model. Second, there are also promising results from some newly devised approaches. One developed by Zarling et al. (2015) is a derivative of Acceptance and Commitment Therapy, often labelled part of the third wave of cognitive-­behavioral therapy. Studies have demonstrated the applicability of this with IPV offenders (Berta & Zarling, 2019; Zarling et al., 2019) and subsequently Lawrence et al. (2021) have reported a study of a further development of it, Achieving Change through Value-Based Behavior, with significant effects in reducing rates of rearrest for IPV. In the next stage of work, it may be that police or court initiatives incorporating such programs will generate better outcomes than those reported hitherto. Amplifying this point, the results of some of the studies included here (Johnson & Goodlin-Fahncke, 2015; Piquero et al., 2006) alongside others (Herrero et al., 2016; Huss & Ralston, 2008; Stare & Fernando, 2014) suggest, not unexpectedly, that there are sub-groups within those who commit family violence offences. There has been extensive work on heterogeneity and on typologies or sub-groups (Boxall et al., 2015; Cantos & O’Leary, 2014; Dixon & Browne, 2003). As well as risk level, individual also vary with regard to the type of violence in which they engage within close relationships. In extreme cases ability to assess this could potentially be useful in estimating risks of femicide (Dixon et al., 2008; Dobash et al., 2007). It could also be used to gauge risk of police officers themselves being assaulted (Johnson, 2011). There is tentative evidence of the potential usefulness of risk assessment instruments specially devised for this purpose (Belfrage et al., 2012; Storey et al., 2013). These findings potentially highlight a differentiated approach to offender management and monitoring by both police and courts, which achieved marked success in studies such as that of Murphy-Geiss et al. (2015).

Other Interventions Space does not allow detailed review of a number of other methods of responding to family violence, but, in any case, there is comparatively much less research on them than on the areas covered above. They include family justice centers (Hoyle & Palmer, 2014), where numerous agencies providing services to victims of family violence operate from a single site, designed to foster victims’ empowerment; an information-sharing and case discussion networking initiative concerned with child abuse in Antwerp, Belgium (De Beeck & Put, 2017); and the use of fathering programs, in which the objective of becoming a better father, which motivates a proportion of men who have committed family violence, is made part of a wider approach to behavior change (Chung et al., 2020). There are very few examples of courts specifically designed to deal solely with cases of child maltreatment. While there is a voluminous literature on many aspects of this, there is very little written on court-based interventions. That may simply be

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because where reported, the neglect or abuse of children are primarily subject to mainstream procedures of criminal investigation and prosecution. There are a few indicators of beneficial effects of dependency court (Malik et al., 2002), of a child well-being court in Miami, Florida (Casanueva et al., 2013), and of a victim-friendly court in Zimbabwe (Musiwa, 2020), but there is not yet a sufficient volume of research to allow any conclusions to be drawn. Similarly, as far as could be ascertained there is no equivalent to DV court in any jurisdiction that deals only with abuse of older adults. Where this has been reported within a family, again it will usually be addressed through the criminal law route. There is very little research published on the efficacy of any specific solutions to such problems. There have been proposals for a standardized screening of isolated, vulnerable elders by first responders (Nusbaum et  al., 2006). In addition, well-­ considered designs of collaboration between police and other agencies for identifying and responding to elders at risk have been formulated and elaborated (Beaulieu et al., 2017) but there is not yet evaluative information available concerning them. The exception to this arises in matters of safeguarding, in situations where an older adult is thought to have been subjected to ill treatment in a residential care home or a similar institutional setting. There is a sizeable research literature on this which is outside the coverage of this chapter; aspects of it were reviewed by McGuire et al. (2021). But as noted earlier, some DV courts are open to addressing any kind of family violence, including abuse of children or elders, and even in other cohabitation arrangements where violence has occurred, for example, between roommates (Tutty & Koshan, 2013).

3 Conclusions It is crucial to keep in mind the challenges of researching the field of family violence. In an area of personal conflicts where there may often be a great deal at stake, there are considerable sensitivities and barriers, and often contradictory attitudes and expectations, giving rise to ever-present legal and ethical dilemmas (Groves & Thomas, 2014). It appears to remain a major challenge to heighten public and policy responses to a problem that until not long ago was largely hidden, denied, or tacitly approved.

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Chapter 13

What About the Child? Bringing Children to the Fore in Australia’s National Domestic and Family Violence Agenda Anita Morris and Cathy Humphreys

A child cannot leave a violent relationship. (Morris et al., 2013)

This chapter examines key aspects of Australia’s current national and state-based domestic and family violence (DFV) policy and practice agendas through the lens of needing to respond to infants, children, and young people. Throughout this chapter, there is deliberate use of the phrase “infants, children, and young people” to hold visible the heterogeneous age and developmental trajectory of the child’s experience of DFV.  The term “domestic and family violence” is commonly used in Australia to describe a range of violent behaviors perpetrated toward family members or intimate partners (Dragiewicz & Burgess, 2016). Drawing on the international DFV context, particularly that of the United States, Canada, and the United Kingdom, this chapter conveys how Australia has been informed and influenced by evidence-based policy and practice from these parts. Australia’s socio-political landscape is discussed with reference to deeply embedded gender norms and stereotypes and the lack of a holistic view of victim survivors and perpetrators of DFV through the lens of family, community, and culture. Infants, children, and young people experiencing DFV are situated within this milieu, and the barriers and opportunities to progressing adequate responses to their experiences are discussed. A way forward is proposed drawing on a case study of state-based DFV reform to illustrate key features that A. Morris (*) Department of Families, Fairness and Housing, State Government of Victoria, Melbourne, VIC, Australia e-mail: [email protected] C. Humphreys School of Social Work, University of Melbourne, Parkville, VIC, Australia © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 P. Sturmey (ed.), Violence in Families, Advances in Preventing and Treating Violence and Aggression, https://doi.org/10.1007/978-3-031-31549-7_13

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underpin the potential emergence of a safe, effective, and appropriate DFV response to infants, children, and young people.

1 The National Domestic and Family Violence Landscape Australia is a country that has benefited from a greater focus on DFV in the past decade. However, despite unprecedented investment and a rolling national strategy and research agenda, shifting the lens to respond systematically and comprehensively to infants, children, and young people’s experiences of DFV has been slow (Campo, 2015; State of Victoria, 2016). Australia has lagged behind international counterparts and the problem goes beyond recognizing children as a homogenous group of DFV victim survivors (Buckley et al., 2007; Noble-Carr et al., 2020). The national DFV agenda in Australia is hampered by a collective blind spot that underpins and sustains the lack of progress. There is the absence of a shared understanding that for all its “fair go” ideals, the undercurrent of Australian values still privileges a patriarchal discourse and “mateship” founded in early colonialism (Carlin et al., 2022; Pease, 2019; Murrie, 2007). Pease (2019) refers to a “violent gender order” that enables and perpetuates violence against women and children. The violent gender order sees patriarchy join with other structural inequalities to create an intersectional prism of risks and barriers for some people, especially Aboriginal women and children (Nixon & Humphreys, 2010; Orr et  al., 2020; Pease, 2019). Gendered drivers of DFV support outdated stereotypes of masculinity, including what it means to be father and caregiver, and fuels coercive and controlling behaviors by predominantly men, against women and children (Heward-Belle, 2016; Morris, 2009). Australia also lacks progress in children’s rights, which hinders a national agenda that must move beyond benevolence (Australian Rights Taskforce, 2018; Tobin, 2015). Progressive and proactive reform over several decades in places like Scotland, have elevated children’s rights and participation generally, and more specifically in DFV response (Houghton, 2017). However, Australia has yet to collectively shift toward a participatory understanding of children and young people experiencing DFV whose voice and agency are critical to meaningful reform (Noble-Carr et al., 2020). The entrenched systemic inequality that hinders DFV responses to infants, children, and young people needs to be addressed at all levels nationally and locally and along a continuum of primary prevention, early intervention or secondary prevention, and tertiary response (Campo, 2015; Fitz-Gibbon et  al., 2022). To achieve real change, a reframing of “family” is needed in the approach to domestic and “family” violence (Stanley & Humphreys, 2017). For example, Australian Aboriginal and Torres Strait Islander communities hold a more encompassing view of “family” as inclusive of extended family and community (Aboriginal and Torres Strait Islander Commission, 2006; Department of Victorian Communities, 2003). However, the DFV statutory and service response has traditionally responded in

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siloed ways to individual women, women and their children, men and marginalized individuals through screening, assessment, allocation and specialist programs and across multiple complex systems (Stanley & Humphreys, 2017; Wilcox, 2010). The narrow view of DFV victim survivors and perpetrators fails to hold a holistic view of families, and of infants, children, and young people, as victim survivors of parental and sibling abuse, as victim survivors of intimate partner violence by other young people, and as young people  who use violence (Campo, 2015). Postseparation violence toward infants, children, and young people is also underestimated. A narrow understanding of DFV has the potential to overlook relational opportunities to respond to children’s experiences of DFV, specifically work to repair and strengthen the safe parent-child relationship that has been undermined by the perpetrator (Campo et al., 2014; Heward-Belle, 2017). A narrow understanding of DFV is likely to also overlook opportunities to consider the child’s relationship with the perpetrator of DFV as well (Lamb et al., 2018).

2 Domestic and Family Violence Experience of Australian Infants, Children, and Young People Despite years of research evidence imploring more accurate and encompassing  language be used in DFV research, policy and practice,  such as a child or children “experiences” DFV, the description that a child or children are “exposed” to DFV or witness DFV  lingers (Australian Institute of Health and Welfare, 2020). The terms “exposed” or “witnessed” DFV are enshrined in national and state legislation (Domestic and Family Violence Protection Act, 2012; Family Law Legislation Amendment [Family Violence and Other Measures Act], 2011; Family Violence Protection Act, 2008), and regularly referred to in research and policy documents (Campo, 2015; Department of Prime Minister and Cabinet, 2021; Orr et al., 2021). Such usage has the potential to influence practitioner mindsets, and in turn their assessments, case notes and court reports, to assume that being present and observing intimate partner violence is the extent of the child’s experience of DFV. To counter this narrative, there has been welcome shift in understanding children and DFV when children are referred to as “victim survivors in their own right” (Meyer, 2020; Morris et al., 2020; State of Victoria, 2021a). As an emerging narrative, the phrase reinforces the view that children should not be seen as “add-ons” to their parent. However, there is still work to do to ensure that the individual child and their own experience of DFV are uncoupled from their sibling group and, indeed, a homogenous group of child victim survivors. What is required is meaningful understanding, identification, and prioritization of the unique risks and needs of the individual child, and expectation of a tailored response. In an adult-focused service system that is geared to working with individual parents, or a parent with their children (usually the mother), outside of statutory services a child is less likely to receive a service response equal to that of either parent in a DFV situation. Statutory response necessitates seeking information about

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and assessing risk to each individual child. In a high-demand environment, child protection services do, and should respond to those most at risk. In these circumstances, the report and investigation would consider all children in the household, nevertheless the response may not include all siblings in a family group. Instead, children experiencing DFV who do not require a statutory response will benefit from a referral pathway that supports an assessment of their particular risks and needs (Humphreys, 2008). Within the context of the child’s experience, it is necessary to understand risks and needs according to age and stage, gender, culture, and other aspects of the child’s identity. Children experiencing DFV are also more likely to be exposed to other forms of violence, known as “polyvictimization” (Finkelhor et  al., 2007, 2011), and these multiple or overlapping forms of abuse have been found to exacerbate or increase risk of future victimization and vulnerability to adversity. Infants, children, and young people also experience the system response, as they and their parents traverse the courts, child protection services, specialist and universal platforms, all with the potential to either neglect, or understand the child and their experience and relationships in different ways (Drinkwater et  al., 2017; Hester, 2011). Radford and Hester (2015, p. 114) have referred to the “double disappearing act” that occurs in system response as DFV becomes the focus and the child’s experience is either sidelined or never emerges. It is difficult to comprehend how children simply disappear from view, when sheer numbers of children in the “system” should warrant increased attention. For example, infants under 4 years of age accounted for the largest number of children accompanying a parent (usually a mother) to specialist homelessness services in national homelessness reporting data (Australian Institute of Health and Welfare, 2012). Perhaps the oversight is somewhat explained by the fact that Australia has not progressed a platform of children’s rights and participation to the extent seen in other comparative countries (Australian Rights Taskforce, 2018; Tobin, 2015). Whilst an inaugural National Commissioner for Children was appointed in 2013, Australia has been slow to develop national policy and practice imperatives to consistently involve children in the design, development, and delivery of services that can greatly impact their lives. To enable such change, increased visibility and participation of children in redefining the DFV service system are required. As a report of the Victorian Family violence Reform Implementation Monitor stated: Children and young people with lived experience of family violence should be ongoing partners in design and implementation, with their voices sought, listened to and acted upon. This is an important area of improvement to ensure systems and services are designed in a way that directly considers the needs of children and young people. (Family Violence Reform Implementation Monitor, 2020)

Most recently, an Aboriginal-led participatory research project that aimed to identify the needs of Aboriginal and Torres Strait Islander children and young people exposed to DFV who come in contact with child protection systems in the state of Queensland found that Aboriginal children’s voices “have often been rendered

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invisible within research on DFV” (Morgan et al., 2022, p. 38) and that more should be done “to hear and respond…including understanding what supports they want and need” (p. 8).

3 Interventions for Australian Children Experiencing Domestic and Family Violence Despite a dearth of child-led DFV program development and the lack of a consistent national approach responding to all children experiencing DFV, Australia has some demonstrated models of best practice interventions and an emerging evidence base for particular cohorts. Tailored interventions for children experiencing DFV are certainly available in Australia; however, they are often situated in community-based programs and lack formal research and evaluation (Campo et al., 2014). This makes it difficult to determine outcomes, compare programs for their feasibility and efficacy, and make an argument for wide-scale implementation within the broader service system. Campo et  al. (2014) argued for a “coherent policy framework that enables service providers, policy makers and researchers to work together collaboratively” (p. 81). Of the programs that are available in Australia, there are some exemplars worth celebrating. Intervention models are available to some Australian infants, children, and young people that innovate to respond to specific cohorts, communities, context, and societal changes. The examples below all integrate the international evidence base, include robust evaluation, and have demonstrated outcomes.

Online Intervention for Young People Empirical research by a national Australian child-focused online and telephone counselling service, Kids Help Line targeted young people aged 13 to 25 years to test the feasibility of a social network group counselling intervention (Campbell et al., 2019). Those who volunteered to participate in the Kids Help Line Circles all had the common experience of “family discord,” which is described as “disharmony among family members, which may or may not include the child; this can include persistent arguments, controlling behaviors, intimidations, and threats” (Campbell et al., 2019, p. 2). The Kids Help Line Circles model is an innovative online approach to create and support social connection in response to young people and their mental health. These types of interventions are reinforced by the need to adapt to a pandemic, evidence advances in technology for psychosocial intervention, and reflect young people’s own preferences for online interventions that understand the ways young people use online technology, are flexible, and enable broader accessibility (Tarzia et al., 2017).

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Infant-Led Work in Shelter Settings The work of Bunston and colleagues (2021; van Daal & Westhead, 2021) in infant-­ led response is one notable example of prioritizing the needs of infants who experience DFV. The research has been situated primarily in refuge (shelter) settings and has trialed interventions such as BuBs on Board (Bunston & Glennen, 2008), a relational mother and infant group intervention trialed in five refuges in the Australian state of Tasmania. The research highlighted the importance of intervening early with infants who have experienced DFV and using the refuge environment as a setting to create space for mothers and children to think, reflect, and relate. More recently, infant-led work has included an exploration of the infant’s inter-­ subjective experience across eight refuges in Australia, England, and Scotland (Bunston et  al., 2021). The research found that despite the impact on their child being the impetus for mothers to leave their violent partner, it was challenging for refuge staff to acknowledge the experience of the infant and to see that they had a role to intervene in supporting the infant directly, not just supporting the mother. The traumatized mother was then expected to be able to meet the infant’s needs in the context of both her own and the child’s psychological distress. Significantly, variations across the three countries in the level of support, options, and length of stay highlighted the extent of disadvantage experienced by mothers and infants in remote areas. The authors argued for adequate training and support for refuge staff to assist them to work alongside mothers in refuge with the goal of early intervention in these infant’s lives (2021).

Group Work for Children in Health Settings The response to infants was part of a suite of interventions to address DFV designed and developed by Bunston and colleagues that originated  within the Integrated Mental Health Program at the Royal Children’s Hospital in Victoria (Bunston, 2006; Bunston et al., 2016). Bunston et al.’ (2016) have argued that programs situated in health can respond holistically and through a relational lens, to children who present to mental health services for DFV related trauma. The Parents Accepting Responsibility Kids Are Safe (PARKAS) program (Bunston, 2008) originated in Melbourne in 1996 and has been delivered in health and community settings. It is a dyadic intervention that has pioneered group work for children who have experienced DFV with their parents or caregivers. Revised and relaunched in 2021, the PARKAS Plus program is available as part of a suite of mental health programs at the Victorian Royal Children’s Hospital. PARKAS, along with other infant-led and child-led work such as the Peek A Boo Club for infants and their parents (Bunston, 2006), has demonstrated the significance of honoring a “child-up” versus “parent-down” (Bunston, 2008 p.  334), psychotherapeutic

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approach, and championed dyadic models of therapeutic intervention with infants and children experiencing DFV long before recent reform in this arena. The pathway to therapeutic interventions frequently relies on universal service system involvement, whether following a disclosure, as part of a multi-service response post an incident, or as part of usual care in recommending or referring to specialist supports, particularly in the context of trauma recovery (Valpied & Hegarty, 2015).

4 Universal Pathways to Identify, Respond, and Refer to Specialist Support Primary health is seen as a key setting to intervene early when children are at risk of DFV (García-Moreno et al., 2014; Hegarty et al., 2020). The Recognize, Respond and Refer model is being rolled out to general practitioners across the country, providing increased knowledge and understanding of DFV, as well as guidance in how to support adults and children experiencing DFV and refer them to tailored or specialist programs (Hegarty et al., 2020). The Safety And Resiliency At Home project, an Australia PhD study that interviewed 23 mother-child dyads, found that DFV interventions in primary care have the potential to elevate the child’s voice and agency within the child-parent-­ practitioner relationship (Morris, 2015). Whilst primary care physicians may lack time to engage the child and parent in particular interventions, they are thought to provide regular review and opportunity to discuss risks and associated health issues for children experiencing DFV, and are well placed to link families to other services for specialist and tailored support (Hegarty et al., 2020). Further opportunities exist with the universal health services to infants and mothers known variously as Community Health Nurses, Child Health Nurses, or Maternal and Child Health Nurses. These child and family health nurses are a key part of maternal and early years health and well-being monitoring in Australia (Schmied et al., 2014). Children in Australia are usually assessed at regular intervals from soon after birth to school entry by a local child and family health nurse. The role of the child and family health nurses in identifying and responding to indicators or disclosures of DFV is a critical one, given a higher rate of hospitalizations for children experiencing DFV, the increased risk of DFV lethality or serious injury during pregnancy and early birth, young children’s inherent vulnerability and dependence on caregivers, and the opportunity to intervene early when working with young families (Adams et al., 2022; Family Safety Victoria, 2019; Orr et al., 2020). Early intervention programs such as Family Foundations are being piloted to respond to this vulnerable period for infants and their mothers and fathers (Giallo et al., 2022). Similarly, early childhood settings are also well placed in this regard and opportunities to engage children and parents are created through regular contact and interactions that may alert educators to changes in child behavior, attendance

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patterns, and parental dynamics. However, it has been argued that early childhood educators, like others in universal settings such as health and education, require capacity building to improve DFV response (Campo et al., 2014). Schools in Australia are viewed as appropriate settings to provide primary prevention DFV education in the form of respectful relationships and consent education (Flood, 2021; Kearney et al., 2016; Smyth & Katz, 2016). Schools and early childhood settings may also be safe settings to identify and respond to children for whom violence is emerging, or is already a key feature of their home life. However, there is limited evidence of best practice early intervention in Australia, which is likely a reflection of both limited programs or practice frameworks, along with limited research and evaluation in this area (Campo et al., 2014). The advantage of the school setting is that it can provide safety and respite for the child experiencing DFV, and adults who they can trust to support them if they disclose, or require ongoing care and support (Fogden & Humphreys, 2021). These relationships enable monitoring for any observable changes in behavior, performance, and attendance. Interestingly, an evaluation of an Australian program for young people using violence in the home found increased engagement in school, improved performance and attendance by the young people involved in the program (Boxall et al., 2020). Clearly in Australia, health and education are viewed as universal services settings that have an important role to play in primary and secondary DFV prevention (Campo et al., 2014; Hegarty et al., 2020). They act as both a gateway to specialist support and as a safety net for those who may not access specialist services and/or continue to rely on the regular support and monitoring of those involved in their day-to-day care and education. Building the skill and confidence of professionals working in these settings to identify and respond appropriately to DFV is essential to the health and well-being of infants, children, and young people experiencing DFV in Australia.

5 International Influences in Responding to Domestic and Family Violence Australia benefits from substantial influence and integration of international DFV research evidence, whilst developing its own robust evidence base contextualized to identity and place. Local research responds to the particularity of the Australian context including Australia’s geographical breadth and remoteness; the experience of our Aboriginal and Torres Strait Islander peoples and their enduring cultural legacy; and a tapestry of global migration in which almost half of Australians (48.2%) have a parent born overseas (Australian Bureau of Statistics, 2021; Lloyd, 2015). Australia’s research agenda must also address the structural and systemic barriers that enable discrimination and increased vulnerabilities for marginalized people from diverse communities.

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Particular models and evidence that have influenced the Australian DFV reform originate from the United States, Canada, and the United Kingdom, to shape local legislation, policy, and practice. The evidence base and key approaches to policy and practice are described below to demonstrate the ways they deliver benefits to children and their families. Improvements to how the models are adapted and implemented locally are critiqued from the perspective of whether children and young people have had opportunities to inform and evaluate the approaches. A key model of DFV intervention targeting the child and family welfare system that has had significant reach in Australia is the Safe and Together model by David Mandel and Associates (Mandel,  2010). The DFV-informed systems approach assists practitioners to see the interplay of the macro societal dynamics which hold men to a lower standard of parenting than women, and the micro-dynamics within DFV relationships where the father’s abusive behaviors undermine the mother’s parenting and family functioning. To address this, the model is founded on three main principles: keeping affected parents and children together, partnering with the affected parent, and holding the perpetrator to account. It overturns traditional system responses that hold women accountable as parents who “fail to protect” their children from the violence, instead of recognizing perpetrators as men who “fail to protect” their families (Moulding et  al., 2015). The Safe and Together model (Mandel, 2010) has complemented and informed Australian DFV responses, evidenced through studies that have focused on particular cohorts or fields of practice including child protection and child and family welfare, intersections of DFV with alcohol and other drugs and mental health, and direct practices with perpetrators (Heward-Belle et al., 2019, 2022; Humphreys et al., 2018). These studies are supported by a national DFV research agenda (Department of Social Services, 2020) and have resulted in the development of a collaborative practice framework for child protection and specialist DFV services arising from the PATRICIA Project with three key practice domains: integrated service focus, democratizing practice, partnership supportive collaboration (Healey et al., 2018, p.  7 of the Research Summary). Practice guidance associated with the Invisible Practices Project identifies five key practice themes: working with fathers who use violence and control, partnering with women, working with children and young people, working collaboratively, and worker safety (Healey et al., 2018, p. 3 of the Practice Guide). These family-focused approaches inform greater understanding of children and young people experiencing DFV and the relational context of their parents with each other, with them and with the system in which the family will be engaged for risk assessment, support, and risk management. Once risks and needs are assessed, infants, children, and young people require therapeutic models of intervention that focus directly on long-term healing and recovery of DFV with children and their caregivers (Morgan et al., 2022). Howarth et al. (2016) undertook a comprehensive systematic review across several countries of controlled and qualitative interventions for children experiencing DFV.  They argue for urgent quality studies, in particular trials, that provide “actionable, generalizable findings” to be able to be implemented in real-world settings and “inform decisions about which interventions to commission and scale” (Howarth et al., 2016

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p. vi). Knowing which interventions are most effective is vital in preventing current health and mental health burden, as well as intergenerational transmission of trauma, and supporting deeper understanding of children’s views, wishes, risks, needs, and relational attachment. However, there is also a role for randomized control trials to inform interventions which support children experiencing DFV. Dyadic therapy for children experiencing DFV has shown positive outcomes for both children and their caregivers, such as Child Parent Psychotherapy (CPP) (Lieberman, 2004; Lieberman et al., 2006) originating in the United States. More recently, CPP has been trained to multidisciplinary professionals across Australia and trialed via the RECOVER project which found that “CPP is acceptable and feasible for this population and can be implemented into the Australian setting, in locations with established DFV system partnerships, service capacity to prioritize mental health and wellbeing responses for very young children, and strong clinical governance structures” (Hooker et  al., 2022, p. 9). Moving the intervention into the Australian context certainly requires more situated research on this method of child-parent therapeutic intervention to address child healing and recovery from DFV. However, the model is already being used in work with community cohorts such as Aboriginal and Torres Strait Islander families, rural families, child mental health clients, and perinatal child protection clients. Therapeutic readiness is required before children and their caregivers can safely engage in interventions such as CPP. Therefore, pathways into these interventions need to be clear, consistent, and universally available at points in the child’s developmental and recovery trajectory. Similar to Australia, the federal Government of Canada shares responsibility for DFV reform with its 13 Provinces and Territories. Key services are delivered by provinces and territories, whilst the federal government provides overarching leadership and guidance, and a national policy agenda. Canada has benefited from government investment in researching and delivering on multi-sectorial reform across intimate partner violence, child maltreatment, and child exposure to intimate partner violence. Reform has been underpinned by a lifespan approach embedded within a public health response focused on child health, trauma informed health promotion, and workforce capability (VEGA Family Violence Project, 2019). “It’s Time: Canada’s Strategy to Prevent and Address Gender-Based Violence” (Government of Canada, 2017) has three pillars: prevention, support for survivors and their families, and promoting responsive and legal and justice systems. The progressive strategy seeks to address gender-based violence across the continuum of primary prevention through to tertiary response. It is underpinned by, and delivered through an intersectional lens. However, like Australia, Canada needs to focus efforts on tailored interventions for children who experience DFV that work with the child in relationship with their safe parent/caregiver (Jenney & Alaggia, 2018). Promising dyadic parenting programs such as Children and Mothers in Mind (CMIM), which has been piloted in Australia, originated in Canadian therapeutic interventions for parent-child dyads. CMIM incorporates models such as Connections psychoeducation group program and Mothers in Mind, a play-group-­ based program, along with 1:1 supports including counselling, case management

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and brokerage (Kertesz et al., 2019). CMIM targets mothers and pre-school aged children who have experienced DFV, and builds on an evidence base of healing and recovery for both parent and young child when interventions are focused on relational work to understand and repair parent-child attachment that has been undermined and damaged by the perpetrator of DFV (Lieberman et al., 2005; Thiara & Humphreys, 2017). The CMIM pilot had 46 mothers participate with their children (Kertesz et al., 2019). During post-program follow-up with the mothers and the program facilitators, an evaluation of the CMIM pilot found that the women described increased understanding and awareness of impact of trauma on their children, benefited from peer relationships in the group setting, the opportunity to form a trusted relationship with the facilitator and learn strategies for their parenting and self-care. The facilitators noted positive shifts in the women toward their children in terms of putting children’s needs ahead of their own and becoming more available to their children. In addition, there was observable moments of joy and connection between children and their mothers. Through mother and facilitator feedback the evaluation also explored participant outcomes. Like similar evaluations of parenting focused interventions (Diemer et al., 2020; Hine et al., 2022), it would have been helpful to understand directly, the child’s experience of this comprehensive dyadic program. Targeting fathers who use DFV, Canada has also pioneered a program known as Caring Dads (Scott et al., 2004). This program has expanded to other parts of the world, including Australia where it has been evaluated in two states in child and family-focused service settings. Unlike CMIM, Caring Dads is a group program for fathers only, and does not involve any dyadic work with their children. However, a key part of the program is engaging with family members affected by the violence through the provision of mother/family contact workers (Diemer et al., 2020; Hine et  al., 2022). Such programs  that focus men on their role as fathers, and taking responsibility for their use of violence are critical interventions to change perpetrator behavior, thereby increasing safety for infants, children, and young people. A focus on fathering is necessary given that children maintain a relationship with their father in the majority of DFV situations, often due to court ordered contact or the perpetrator’s ongoing involvement in their lives. Both mother and child safety is considered a key outcome of men’s involvement in such programs (Hine et  al., 2022; Humphreys et al., 2018). Findings from two evaluations of the Caring Dads program in Australia (Diemer et al., 2020; Hine et al., 2022) show overall improvements in father’s insights and behaviors toward their children and the child’s mother, a reduction in abusive behaviors, and improved well-being for both fathers and mothers. These findings are based on triangulated feedback from fathers, mothers, and facilitators. A limitation of each evaluation has been the inability to capture children’s voices and feedback about what has changed for them as a result of their father’s participation, and mother’s support throughout the program. However, the evaluation of pilot programs in Victoria has been able to describe several recommendations for the continuation of Caring Dads programs in Australia, including to be available beyond the standard 17-week program and linked to related

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interventions and supports (Diemer et al., 2020). Given the focus on the fathering, the model needs to embed direct to support children and consistent monitoring of father-child contact for the duration of the program. There is an important dual role within Caring Dad’s programs to support participant’s understanding of, and accountability for the impacts of DFV on their children, as well impacts on their adult partner/ex-partner and safe parent-child relationship. In addition, such programs create opportunities to message respectful behaviors toward women. The program has acceptability within the Australian context if local, culturally relevant materials are used as examples to supplement standard content (2020). Support to safe parents (mothers) and staff involved in delivering the program are critical enablers. A review of international influence on Australian DFV policy and practice would not be complete without addressing the influence of the United Kingdom and progressive thinking in responding to infants, children, and young people (Arai et al., 2021; Stanley & Humphreys, 2017). Foundational UK studies (McGee, 2000; Mullender et al., 2002) have listened to children directly about their experiences of DFV and informed Australian research grounded in children’s experiences and what children tell us that they want and need from a service response (Lamb et al., 2018; Morris, 2015; Mudaly & Goddard, 2006). A significant program adoption is the Muti Agency Risk Assessment Conferences (Robinson, 2004) that originated in the UK and have been implemented in Australia as various forms of high-risk panels that encourage multidisciplinary assessment and risk management of families experiencing DFV (Backhouse & Toivonen, 2018). Reform of this type has been understood to directly intervene when risk is escalating through a forum that supports and enables information sharing between key agencies (Centre for Innovative Justice, 2015). These examples of DFV reform from other parts of the world that share similar cultural and economic characteristics and evidence similar incidence and characteristics of DFV have illustrated the significance of the international evidence base in shaping and guiding a localized and contextualized evidence base for DFV intervention in Australia.

6 Promising Reform There is much to celebrate in the progress Australia has made to invest in and deliver a national agenda that sought to reduce violence against women and children between 2010 and 2022 (Commonwealth of Australia, 2010). Australia is embarking on a further ambitious commitment with a National Plan to end violence against women and children (Commonwealth of Australia, 2022) that will see five-year action plans, with dedicated Aboriginal and Torres Strait Islander action plans, implemented through to 2032. It has been argued that there needed to be a greater focus on children and young people in the new National Plan, in particular child-centric risk practices generally,

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and child-centric approaches in the Family Court arena (Fitz-Gibbon et al., 2022). Like Morgan et al. (2022), those with lived experience of DFV have argued for better supports for children involved in the child protection system and placed in out of home care as a result of DFV (Fitz-Gibbon et al., 2022). Reforms are yet to truly shift the narrative to preventing men’s violence to more accurately describe the gendered nature of violence and predominance of men as perpetrators of violence. However, the new National Plan (Commonwealth of Australia, 2022) has commitment from federal, states, and territory governments to work together with endorsement from the Council of Australian Governments. Sexual violence and harm toward women and children are also in the spotlight in Australia due to the Royal Commission into Institutional Responses to Child Sexual Abuse (Commonwealth of Australia, 2017) and the courage and advocacy of prominent young women such as Grace Tame, the 2021 Australian of the Year who was sexually abused by a trusted teacher at her school (Allman, 2021). The tenacity of Grace and other young Australian women who have spoken out about their experiences of sexual abuse perpetrated by men in positions of authority and trust has followed the global “Me Too” movement (Hillstrom, 2018) and made it possible for Australia to consider more urgently the need for change in consent laws and education in Australia (Keddie, 2021). A ten-year National Strategy to Prevent and Respond to Child Sexual Abuse (Department of Prime Minister and Cabinet, 2021) will address the recommendations of the Royal Commission into Institutional Responses into Child Sexual Abuse (Commonwealth of Australia,  2017) and go beyond institutions to prevent and respond to child sexual abuse perpetrated by family members and those outside of the family, including online. The strategy is a first for Australia and aims to “reduce the risk, extent and impact of child sexual abuse and related harms in Australia” (Department of Premier & Cabinet, 2021, p. 20). Through a public health approach, the ambitious plan aims to also address other areas of childhood adversity including other forms of child abuse and DFV. To achieve this, more contextualized assessment and intervention will need to be embedded in practice for those working with infants, children, and young people and their caregivers to better respond to the intersections and complexity of various forms of child abuse, including child sexual abuse in a DFV context.

7 Case Study There remains an urgent national gap in addressing responses to infants, children, and young people experiencing DFV, despite promising reform and small-scale examples of best practice. However, one state in Australia has been implementing large-scale reform to address DFV. The Royal Commission into Family Violence (State of Victoria, 2016) was held in the State of Victoria and handed down 227 recommendations, all of which the government of the day accepted. The Victorian experience is used here as a case study to illustrate the gains to be made through

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substantial investment in systemic reform. The foundational reforms implemented and the gaps that remain, now that the DFV reforms are in their seventh year, are discussed in the context of a greater focus on outcomes. Examples that include multi-agency capability uplift and engagement in DFV response across sectors such as child protection, child, and family services, Aboriginal community-controlled organizations, police, courts, and specialist DFV response are shared to illustrate multisector uptake and embedding of substantial DFV reform to create a joined up system (Wilcox, 2010, p. 1036). It is foundational system reform that is beginning to mature, and therefore is better able to focus on the needs of infants, children and young people experiencing DFV. As we have shown, international and national research evidence has provided useful models to understand, prevent, and respond to DFV in Australia and these have been incorporated into Victorian practice frameworks, legislation, and policy changes (Backhouse & Toivonen, 2018; Lamb et  al., 2021). They also influence where and how the research, policy, and practice agenda needs to progress to fully realize an approach that responds effectively to infants, children, and young people. A multi-agency model of safety and support hubs is being implemented across the State of Victoria (2020a). Known as The Orange Door, each of the services has a physical presence in the local community area, may have satellite sites in neighboring areas, and out-reach services for increased accessibility (State of Victoria, 2020a). The Orange Door is the realization of one of the key recommendations of the Royal Commission into Family Violence, and of the Roadmap to Reform: Strong Families, Safe Children, the strategy to transform Victoria’s child and family system (State of Victoria, 2020a). The Orange Door brings together a statewide integrated practice approach to responding to DFV and to child well-being (Family Safety Victoria, 2018a; State of Victoria, 2016). The Orange Door is described as “a free service for adults, children, and young people who are experiencing or have experienced DFV and families who need extra support with the care of children” (Family Safety Victoria, 2018b). Through a screening, intake and triage model The Orange Door brings together DFV services and child and family services, with links to the broader universal and tertiary service sectors to respond holistically to families in need (State of Victoria, 2020a). In particular, The Orange Door can be seen as a central link to DFV victim survivor and perpetrator involvement in police, court, child protection, Aboriginal services and specialist service responses to DFV as it supports increased connection and participation in the broader DFV system. The early implementation of the Royal Commission (State of Victoria, 2016) recommendations also saw the introduction of legislation that prescribes agencies to align with a Multi-Agency Risk Assessment and Management Framework, known as MARAM and Information sharing legislation, known as the Family Violence Information Sharing Scheme and the Child Information Sharing Scheme (Family Safety Victoria, 2019). These foundational legislative reforms have provided a shared understanding and shared language of DFV across a broadened DFV sector that includes statutory and emergency response, health, mental health, education, housing and homelessness, child and family services including out of home care,

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financial counselling and tenancy programs, the alcohol and other drugs sector, some government agencies and oversight bodies. The breadth of prescription provides system level change with key enablers such as consistent practice guidance, tools and training as well as implementation oversight and evaluation. A 10-year industry plan, Ending Family Violence: Victoria’s Plan for Change, comprises rolling action plans that support extensive DFV multi-sector capability uplift and capacity building (State of Victoria, 2020b). Of a vast array of initiatives, some key actions of the plan include development of prevention and response workforce capability frameworks; the Victorian Survivor Advisory Council; the introduction of specialist family violence courts; minimum qualifications for those working in the specialist DFV sector, alcohol and other drug and mental health DFV advisor roles; new perpetrator intervention programs; and Dhelk Dja: Safe Our Way  – Strong Culture, Strong Peoples, Strong Families which is the Victorian Aboriginal-led agreement to address family violence in Aboriginal communities. Reforms that specifically focus on infants, children, and young people have generally been slower to be introduced than adult focused prevention and response initiatives. However, this is now beginning to shift as the reform agenda matures and more detailed design and development of responses to specific cohorts are progressed. An early MARAM child risk assessment tool was developed as part of the initial release of victim survivor-focused guidance and tools in mid-2019 (Family Safety Victoria, 2019). Current work underway in Victoria includes the Child and Young Person Risk and Wellbeing MARAM project that will see further development of child-centered risk and well-being products to support practice as part of the broader MARAM suite of tools and guidance (Monash University, 2022). The new products will be informed by children and young people with lived experience of DFV to inform the approach. The evolving suite will include specific guidance and tools for working with young people who use DFV (State of Victoria, 2021a). The project focus of involving children at the outset represents a significant shift in the way children and young people are being engaged in the development of critical tools that are used to understand, assess, and manage risk to infants, children, and young people. Victoria Police have aligned their risk assessment and management report, known as an L17 report to MARAM, and as part of the alignment they have increased the focus on children through the ability to speak directly with children at the incident, seek further information about children in the household, and assess children’s safety needs independently of the adults involved. Further actions that can be taken include referrals to services that can respond to the needs of children and families (Victoria Police, 2019). An L17 Portal provides direct links to The Orange Door, Child Protection and the specialist family violence service sector to enable seamless referral of DFV incidents when police are involved, into the broader service response. Victoria Police are also integral members of the Victorian high-­ risk DFV panels, known as Risk Assessment and Management Panels, or RAMPs (Centre for Innovative Justice, 2015). They sit regularly with other representatives of the DFV system response across the state in Victoria to provide “a coordinated multi-agency approach and dedicated case management service” to victim survivors

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at the highest risk of serious injury or lethality (State of Victoria, 2016, p.  20). RAMP activities are aligned to MARAM and include representatives from Child Protection as well who can consider the necessary response to infant, child, and young person safety in these matters. In the 12 months prior to the first release of MARAM guidance and tools, the Victorian Child Protection program received a comprehensive training program in DFV underpinned by an evidence-based theoretical practice model known as Tilting our Practice (State of Victoria, 2022). The model was co-developed by leading social work academics and practice leaders in child protection. It drew upon the contemporary DFV and related evidence base, including international and local influences such as the Safe and Together model (Mandel, 2010); other key research about working with DFV perpetrators as parents (e.g., Bancroft et al., 2002); DFV approaches from Australia and the UK in understanding and responding to children (e.g., Holt et al., 2008; Kaspiew et al., 2017) including relational work with safe parents (e.g., Humphreys, 2011); findings of the Royal Commission into Family Violence (State of Victoria, 2016); best practice approaches when working with Australian Aboriginal children and families (e.g., Atkinson, 2013); and the practice frameworks underpinning the current child protection program in Victoria (Department of Human Services, 2012a, b, 2013). Tilting our Practice is based on four key elements: the child’s experience, a focus on perpetrator accountability, collaborating with the adult victim survivor, and attending to practitioner safety (State of Victoria, 2022). These elements are underpinned by an intersectional lens and a trauma and violence informed approach to practice. Since late 2021, the Tilting our Practice model has been further embedded in practice through the development and rollout of a new Victorian Child Protection risk assessment framework, known as SAFER (State of Victoria, 2021b), which uses a guided professional judgement approach to assessing risk and working with infants, children and young people. Both Tilting our Practice and SAFER are aligned to MARAM and promote the seeking and sharing of information to assess and manage risk. The need to support infants, children, and young people who require a longer-­ term therapeutic response to the trauma they have experienced from DFV is recognized within Victoria’s 10-year industry plan (State of Victoria, 2020b). Initially conceived as 22 therapeutic demonstration pilot projects delivered by mainstream child and family services and four delivered by Aboriginal communitycontrolled organizations, the pilot projects were for services to both children and adults and they were independently evaluated to inform client outcomes, development of sector capability, cost efficiency, scalability, and replicability (Ernst & Young, 2019, p. 9). The pilot projects and subsequent evaluations have led to a statewide therapeutic interventions program that provides therapeutic services to both children and adults with consistent features informed by the previous evaluation. The key features that are embedded in programs that received funding include flexibility, holistic interventions, long-term-resilience building, clientcentered, and relationship focused interventions (2019). There was recognition of the specific needs of children and young people, including relational family-based responses and programs specifically for young

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people using violence. One particular program, known as TRAK Forward (Morris et al., 2019), delivers a parent/child-based model comprising child/parent therapy with a dedicated therapist, group-based recovery programs, and a peer support program. An evaluation of the TRAK Forward program found that benefits to children included non-detectable disordered infant attachment following detection at baseline, significant reduction in child emotional difficulty, and significantly increased parental empowerment and efficacy. Children reported that the activities were fun and noted positive change in their parents. The Victorian example of DFV reform is vast and varied. It is difficult to encapsulate the scope of system reform underway, let alone describe all of the elements that are specific to infants, children and young people. This case study has demonstrated reform in how the system can identify, assess, and respond to children when all of the system enablers are put in place. The reform journey can never be rushed when deep cultural change is required. Indeed, broader socio-cultural factors such as national progress on children’s rights and participation are required to meaningfully reframe responses to all children experiencing DFV.  However, the Victorian reforms exemplify what is possible with enough motivation, investment, and vision.

8 Learnings Hester (2011) introduced us to the three planets model to represent siloed sector responses to infants, children and young people experiencing DFV. The Australian experience of differential response across DFV services, child protection, and child contact post-separation certainly resonated with the UK experience at that time. In the years since, globally there has been increased understanding of the impacts of DFV on infants, children, and young people and increased visibility of their experiences and agency as victim survivors in their own right (Campo, 2015). Substantial research evidence in this arena has influenced incremental yet significant shifts in policy and practice within each of the spheres that Hester exposed. Australia has been slower than some international counterparts to progress a deeper understanding of gender inequality, move beyond patriarchal discourse, and embed a children’s rights and participation framework that centers the lived experience of infants, children, and young people in Australia. However, there are signs of progress that lead the way to supporting evidence-based, consistent, best practice approaches to all children in Australia living with DFV. The following five key features should be evidenced in system-based approaches to DFV response to infants, children, and young people (see Table 13.1).

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Table 13.1  The five key features in system-based approaches to DFV response to infants, children, and young people 1. Child-led: Children have a right to participate in all stages of planning how the system understands and responds to each child within the family through a framework of lived experience that puts children at the center. Adequate resource and support of children’s participation in all aspects of design, development, and delivery are required. 2. Family-focused: A more holistic view of “family” within Australian DFV policy, practice guidance, and practitioner mindsets would enhance responses to each child within a family. Services responses to infants, children, and young people require an inclusive, developmental, and trauma informed lens that works together with safe parents and caregivers for children’s healing and recovery. 3. Intersectional: Systemic and structural inequality creates barriers to access and engagement. All services should attune to the needs of each child within the family and seek an assessment that incorporates the child’s developmental age and stage, cultural and other characteristics that situate the child’s risks and needs within their familial and social context. Strengths, protective factors, and connections to family, community and culture are critical enablers and should be identified and reinforced. 4. Always evidence-informed, and where possible evidence-based: As understanding and response to DFV evolves, there will always be a need for an evidence base that is contextualized to person and place. We owe it to infants, children, and young people to invest in research that values their input, helps them participate in meaningful ways, and contributes to outcomes that are meaningful to them. 5. System enablers: Infants, children, and young people are part of families and communities and integrated in community life across many services and systems. DFV responses need to replicate this integration through shared language and shared understanding. The enablers are multi-sector guidance, tools, legislative and policy frameworks, program features, workforce capabilities, accessibility, resourcing and funding models, data capture and reporting, and ultimately a clear and consistent vision and required outcomes.

9 Conclusion Australia lacks a comprehensive and consistent response to infants, children, and young people experiencing DFV, despite recent investment and evidence-building in broader DFV response. Key issues include a continuing patriarchal discourse, language that situates children to the DFV sidelines, and the lack of a children’s participation rights approach that hinder efforts for change. However, this chapter has shown through an exploration of critical influences such international contemporary DFV evidence and localized exemplars, that Australia can demonstrate an emerging foundation of best practice DFV responses to infants, children, and young people. Using a state-based case study of DFV reform, it is argued that there is potential to realize a consistent system-based approach to DFV best practice for infants, children, and young people. Through a system response that integrates five key features: child-led, family-­ focused, intersectional, evidence informed  and evidence based, with consistent system enablers, we have argued that safe and effective practice with infants, children, and young people experiencing DFV can be achieved. Infants, children, and young people are Australia’s most important investment and our most critical evaluators because the outcomes are their future.

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Stanley, N., & Humphreys, C. (2017). Identifying the key components of a ‘whole family’ intervention for families experiencing domestic violence and abuse. Journal of Gender- Based Violence, 1(1), 99–115. State of Victoria. (2016). Royal commission into family violence: Summary and recommendations, Parl. Paper No 132. Victorian Government. State of Victoria. (2020a). The Orange door service specifications. Victorian Government. State of Victoria. (2020b). Family violence reform rolling action plan 2020–23. Victorian Government. State of Victoria. (2021a). Annual report on the implementation of the multi-agency risk assessment and management framework, Victorian Government 2020–21. Victorian Government. State of Victoria. (2021b). SAFER children framework. Victorian Government. State of Victoria. (2022). Tilting our practice. Victorian Government. Tarzia, L., Iyer, D., Thrower, E., & Hegarty, K. (2017). “Technology doesn’t judge you”: Young Australian women’s views on using the internet and smartphones to address intimate partner violence. Journal of Technology in Human Services, 35(3), 199–218. Thiara, R. K., & Humphreys, C. (2017). Absent presence: The ongoing impact of men’s violence on the mother–child relationship. Child & Family Social Work, 22(1), 137–145. Tobin, J. (2015). Understanding children’s rights: A vision beyond vulnerability. Nordic Journal of International Law, 84(2), 155–182. Valpied, J., & Hegarty, K. (2015). Intimate partner abuse: Identifying, caring for and helping women in healthcare settings. Women’s Health, 11(1), 51–63. van Daal, E., & Westhead, P. (2021). Early intervention for homeless infants begins in refuge. Parity, 34(8), 53–54. VEGA Family Violence Project. (2019). McMaster University, Ontario, Canada. https:// vegaproject.mcmaster.ca/ Victoria Police. (2019). Code of practice for the investigation of family violence edition 3 v4 (Interim). State Government of Victoria. Wilcox, K. (2010). Connecting systems, protecting victims: Towards vertical coordination of Australia’s response to domestic and family violence. University of New South Wales Law Journal, 33(3), 1013–1037.

Chapter 14

Family Violence in U.S. Military Families Joel S. Milner, Julie L. Crouch, Joe Ammar, Wendy J. Travis, and Valerie A. Stander

Family violence (FV) is a pervasive, worldwide social problem with numerous adverse short- and long-term consequences for victims and their families (Centers for Disease Control and Prevention, 2021a, b; World Health Organization, 2020a, b). Like civilian families, U.S. military families experience all forms of FV. However, counter to what some may believe, reported child maltreatment incidence rates for U.S. military families (U.S. Department of Defense [DOD], 2021a), which we will detail in this chapter, are substantially lower than child maltreatment incidence rates reported for civilian families (U.S.  Department of Health and Human Services [USDHHS], Administration for Children and Families [ACF], Administration on Children, Youth and Families [ACYF], Children’s Bureau [CB], 2021). In our description of military FV, we use the definition found in the U.S. Department of Defense (DOD) annual report of FV incidence rates in U.S. military families (U.S. DOD, 2021a). Similar to civilian definitions (e.g., Barnett et al., 2010; USDHHS, 2019), the DOD defines FV as child abuse (CA) or domestic abuse (DA) that is physical, sexual, emotional, or neglectful in nature. In response to FV, the U.S. DOD has increasingly sought to refine its efforts to detect, treat, and prevent violence in military families as well as promote and maintain healthy military families (Milner, 2015; Travis et al., 2015). Some of these efforts will be described in this chapter. Prior to 1981, each U.S. military branch had a separate Family Advocacy Program (FAP) that managed FV issues (Kamarck et  al., 2019). Currently, the U.S. military FV prevention, detection, and intervention activities are administered J. S. Milner (*) · J. L. Crouch · J. Ammar · W. J. Travis Center for the Study of Family Violence and Sexual Assault, Northern Illinois University, DeKalb, IL, USA e-mail: [email protected]; [email protected]; [email protected]; [email protected] V. A. Stander Purdue Military Family Research Institute, West Lafayette, IN, USA © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 P. Sturmey (ed.), Violence in Families, Advances in Preventing and Treating Violence and Aggression, https://doi.org/10.1007/978-3-031-31549-7_14

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centrally by the U.S.  DOD FAP.  Established in 1981, the DOD FAP is a congressionally-­mandated program that manages DOD’s Coordinated Community Response to FV (Borden et al., 2017). The Coordinated Community Response is a collaborative victim-centered approach designed to respond to CA, DA, and children‘s problematic sexual behavior in military families (U.S. DOD, 2019a). FAP services are coordinated with military commands, military and civilian law enforcement personnel, judicial and legal services, military and civilian medical staff, military family centers, military chaplains, civilian child protective service providers, and other stakeholders in the community (U.S. DOD, 2019a). An overall DOD FAP manager is stationed in the Office of the Deputy Assistant Secretary of Defense for Military Community and Family Policy in Washington, DC. With the exception of the Space Force, in each military service (i.e., Army [Department of the Army], Navy and Marine Corps [Department of the Navy], Air Force [Department of the Air Force], and Coast Guard [Department of Homeland Security]), at installations with command sponsored families, a FAP manager, who is appointed by a command representative, implements and manages local FAP services (U.S.  DOD, 2019a). The National Defense Authorization Act for Fiscal Year 2020, Pub. L.  No. 116-92 (2019) established the U.S.  Space Force as an additional DOD military service. Currently, the Space Force does not have a separate FAP. FV incidents involving members of the Space Force are managed by the nearest Air Force FAP (U.S. Government Accountability Office, 2021). The U.S. military ensures FV service providers are appropriately educated and trained. FAP managers must have a masters or doctoral-level degree in the behavioral sciences. FAP managers also must have a clinical license and five or more years of experience working in the FV field and at least 3 years of previous experience supervising clinicians (U.S.  DOD, 2019a). Installation level FAP staff who provide clinical services to FV victims, FV perpetrators, and other family members must have a masters or doctoral-level degree in an appropriate area of human services or mental health and a clinical license with two or more years of experience working in the FV field. For FAP staff treating families where problematic child and youth sexual behavior has occurred, additional training is required. During their employment, FAP clinicians must complete annual continuing education training as required by their state of licensure (U.S. DOD, 2019a).

1 Definitions of Family Violence The definitions of child maltreatment used by each of the U.S. states and the U.S. military are guided by standards provided in the Child Abuse Prevention and Treatment Act and in the Child Abuse Prevention and Treatment and Adoption Reform (2010). However, both the states and the military have developed definitions that extend beyond the minimum standards cited in these legislative

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documents. Because of this, U.S. child maltreatment as well as DA definitions vary widely across states (National Conference of State Legislatures, 2019; USDHHS, 2019) and sometimes even vary within states. For example, child maltreatment definitions found in state criminal codes can differ from definitions found in state juvenile codes (National Conference of State Legislatures, 2019). Likewise, the majority of states have DA definitions in state criminal codes that vary from DA definitions in state domestic relations or social services codes (USDHHS, 2019). To ensure standardization of the DOD child maltreatment and DA definitions across the military community, detailed operationalized definitions for each child maltreatment and DA type were developed (i.e., physical abuse, sexual abuse, emotional abuse, and neglect). Definitions for each child maltreatment and DA type include three components: Part A, the act (e.g., did a non-accidental act occur?), Part B, the impact (e.g., were there nontrivial impacts?), and Part C, the exclusions (e.g., are there exclusions that apply to Part A?). During development, the child maltreatment and DA definitions were field tested and modified based on empirical utility. This work, initially conducted under contracts funded by the U.S. Air Force, is described in detail in scholarly publications (e.g., Heyman et al., 2010; Heyman & Slep, 2006, 2009: Slep & Heyman, 2006).

DOD Child Maltreatment Definitions With respect to child maltreatment, DOD defines a child as “an unmarried person under 18 years of age for whom a parent, guardian, foster parent, caregiver, employee of a residential facility, or any staff person providing out-of-home care is legally responsible. The term means a biological child, adopted child, stepchild, foster child, or ward. The term also includes a sponsor’s family member (except the sponsor’s spouse) of any age who is incapable of self-support because of a mental or physical incapacity, and for whom treatment in a DOD medical treatment program is authorized” (U.S. DOD, 2017a, p. 11). Using this definition of child, the DOD defines child maltreatment as “the physical or sexual abuse, emotional abuse, or neglect of a child by a parent, guardian, foster parent, or by a caregiver, whether the caregiver is intrafamilial or extrafamilial, under circumstances indicating the child’s welfare is harmed or threatened. Such acts by a sibling, other family member, or other person shall be deemed to be child abuse only when the individual is providing care under expressed or implied agreement with the parent, guardian, or foster parent” (U.S. DOD, 2017a, p. 11). The DOD definitions for each type of child maltreatment are listed in Table 14.1. A complete listing of the Part A criteria, Part B impact, and Part C exclusions (when there are exclusions that apply to Part A) used to define child physical abuse, child sexual abuse, child emotional abuse, and child neglect are available elsewhere (U.S. DOD, 2021b, pp. 17–27).

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DOD DA Definitions DA is defined as “a pattern of behavior resulting in emotional/psychological abuse, economic control, and/or interference with personal liberty that is directed toward a person who is: a current or former spouse, a person with whom the abuser shares a child in common; or a current or former intimate partner with whom the abuser shares or has shared a common domicile” (Kamarck et al., 2019, p. 6). DOD definitions for each type of DA are listed in Table 14.1. A complete listing of the Part A criteria, Part B impact, and Part C exclusions (when there are exclusions that apply Table 14.1  DOD definitions of types of child maltreatment (CM) and domestic abuse (DA) Type of abuse CM – Physical abuse CM – Sexual abuse

CM – Emotional abuse CM – Neglect

DA – Physical abuse DA – Sexual abuse DA – Emotional abuse

DA – Neglect

DOD definition The non-accidental use of physical force that causes or may cause a significant impact and that does not include discipline administered by a parent or legal guardian to his or her child provided it is reasonable in manner and moderate in degree and other does not constitute cruelty. The employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such; of the rape, and in cases of caretaker or inter-familial relationships, statutory rape, molestation, prostitution, or other forms of sexual exploitation of children, or incest with children. Non-accidental acts resulting in an adverse effect on the child’s psychological well being including intentional berating, disparaging or other verbally abusive behavior toward the child, and excessive disciplinary acts that may not cause observable physical injury. The negligent treatment of a child through egregious acts of omissions below the lower bounds of caregiving, which shows a striking disregard for the child’s well being, under circumstances indicating that the child’s welfare has been harmed or threaten by deprivation of age-appropriate care. The non-accidental use of physical force against a spouse or intimate partner that causes physical injury (e.g., bruise, cut, sprain, or broken bone) or reasonable potential for more than inconsequential physical injury. The use of physical force to compel the spouse or intimate partner to engage in a sexual act or sexual contact against his or her will, whether or not the sexual act or sexual contact is completed. Non-accidental act or acts, excluding physical or sexual abuse, or threats adversely affecting the psychological well-being of the partner (e.g., isolating partner from friends/family; restricting access to economic resources or benefits; threating to harm the individual’s children, pets or property; or berating, disparaging, or humiliating the partner). Withholding or threatening to withhold access to appropriate, medically indicated healthcare, nourishment, shelter, clothing, or hygiene where the spouse is incapable of self-care and the abuser is able to provide care or access to care.

Note. DOD = Department of Defense. The definitions of child maltreatment and Domestic Abuse are quoted from the DOD Manual 6400.01, Volume 3, Family Advocacy Program (e.g., U.S. DOD, 2021b) and from Families and Intimate Partner Violence: Background and Issues for Congress (Kamarck et al., 2019)

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to Part A) used to define DA physical abuse, sexual abuse, emotional abuse, and neglect are available elsewhere (U.S. DOD, 2021b, pp. 27–33). In fiscal year 2006, an additional category, “Intimate Partner Abuse” was added to DOD DA classification schema. However, it was not until fiscal year 2009 that Intimate Partner Abuse was included as a separate category in the annual DOD report on “Child abuse and neglect and domestic abuse in the military” (U.S. DOD, 2018, p. 49). In 2015, the scope of DA was expanded to include “former and current same-sex spouses in a legal union recognized as a marriage by a state or other jurisdiction. This rule extends benefits to same-sex spouses of Military Service members and DOD civilians following the June 26, 2013 U.S.  Supreme Court decision to declare Section Three of the Defense of Marriage Act unconstitutional” (Family Advocacy Program [FAP], 2015, p. 11778).

2 DOD Reporting Instructions for Suspected Child Maltreatment and DA Incidents Child Maltreatment Reporting The DOD reporting requirements for suspected (i.e., is there reasonable suspicion abuse has occurred?) incidents of child maltreatment are described in Section 575 of Public Law 114-328, the National Defense Authorization Act for Fiscal Year 2017 (2016). Section 575 specifies that all individuals in a service members’ chain of command and all military professionals involved with service members and their families (such as military child-care providers) must immediately report suspected child maltreatment to the FAP office at the installation where the service member is assigned regardless of where the suspected incident occurred. Section 575 also requires that all suspected child maltreatment incidents involving service members or their families be reported to the local state civilian child protective services agencies. In addition, all suspected child maltreatment incidents must be reported to military law enforcement for a determination of the need for legal action (U.S. DOD, 2019b).

DA Reporting Unrestricted Reporting Similar to instances of suspected child maltreatment, the DOD requires that suspected DA be immediately reported. An unrestricted report of DA can be made by a DA victim or by any concerned individual to any person in the chain of command, to any FAP staff member, or to any military law enforcement personnel (U.S. DOD, 2017b), who will initiate an investigative process. With the exception

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of restricted reports (see next section), when a DA report is made to FAP, the report is forwarded to law enforcement. Likewise, when a DA report is made to someone in the chain of command or to law enforcement, they must, in turn, refer the report to FAP (U.S. DOD, 2017b). Restricted or Confidential Reporting The DOD has a policy for the restricted or confidential reporting of DA by adult victims (U.S. DOD, 2017b). Restricted reporting of DA was instituted because in some cases DA victims have concerns about their safety should the offender learn about their report of DA. In cases where the DA victim requests a restricted or confidential report, DOD has granted FAP clinicians, FAP victim advocates, and victim health-care providers the authority to keep DA incident information confidential. However, under the restricted reporting regulations, the DA victim still has access to FAP services, including medical care, counseling, and support from a victim advocate. Restricted or confidential reporting does not apply to child maltreatment (U.S. DOD, 2017b).

3 DOD FV Incident Determination Processes After the development of the previously described DOD child maltreatment and DA standard definitions, procedures were developed to systemize the review process used in determining whether reported child maltreatment and DA incidents meet the DOD definitional criteria for child maltreatment and DA (U.S.  DOD, 2021b, pp.  17–33). Across the DOD, Incident Determination Committees conduct these assessments. Furthermore, depending on the outcome of these assessments and the severity of met criteria incidents (i.e., if there have been fatalities), additional review committees also may be convened. The incident determination replaces the former incident “substantiated” process. A structured format for assessing FV allegations was deemed necessary to increase the reliability and reduce potential bias found in the former child maltreatment and DA substantiation decision-making process.

Incident Determination Committee Following the report of a suspected FV incident to FAP, Incident Determination Committees use a structured process to decide whether the allegation of FV “meets” or “does not meet” the DOD child maltreatment or DA definitional criteria (U.S. DOD, 2019b). More specifically, the Incident Determination Committee uses a computer-based, automated decision tree to make determinations as to whether reported incidents of FV meet the DOD child maltreatment and DA criteria (see

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U.S. DOD, 2021b, for a complete listing of the child maltreatment and DA criteria). In a step-by-step process, Incident Determination Committee members discuss and vote on each criterion individually. When a reported incident meets the definitional criteria (known as the incident status determination), the case is entered into a DOD FAP Central Registry of child maltreatment and DA cases (U.S. DOD, 2019b). In order to protect the privacy of service members, Incident Determination Committee membership is prescribed and is limited only to those who hold specific roles on the installation. The Incident Determination Committee Chair is the Deputy to the installation commander, and the advisor to the Chair is the senior enlisted noncommissioned officer at the installation. Along with the installation FAP manager or FAP supervisor of clinical services, other Incident Determination Committee members include representatives from the Service member’s chain of command and the judge advocate’s office (U.S.  DOD, 2021b, p.  13). Further, there has been a recent change in the prescribed Incident Determination Committee membership. The William M. [Mac] Thornberry National Defense Authorization Act for Fiscal Year 2021 (2021) specifies that the Incident Determination Committee voting membership will include medical personnel with the knowledge necessary to determine whether a child maltreatment report meets the DOD child maltreatment criteria. Only when appropriate are other professionals invited to participate in the Incident Determination Committee decision making process (U.S. DOD, 2021b, p. 13). It is important to note that the Incident Determination Committee process is not a disciplinary proceeding. As stated previously, the Incident Determination Committee process is an administrative process to determine whether an alleged incident meets criterion for FV and therefore should be logged into the Central Registry, and whether the incident meets the threshold for the provision of FAP clinical services, which includes treatment, safety planning, and victim protection (U.S. DOD, 2021a). Separate from the Incident Determination Committee, military law enforcement, military criminal investigative staff, military justice officers, and military commanders make decisions about the legal ramifications of the FV incident (Barna, 2018). Since Incident Determination Committee criteria and legal criteria for FV differ, in some cases, the Incident Determination Committee will find that an alleged FV event meets criteria when there is not sufficient evidence for punishment in the military justice system (U.S. DOD, 2021b).

Clinical Case Staff Meeting Following a case determination status of “met criteria” by the Incident Determination Committee, cases are further reviewed at the FAP clinical case staff meeting, which develops a treatment plan that includes intervention(s), safety planning, and general case management, including case transfers and closures (U.S.  DOD, 2021b). As previously discussed, there is a provision for DA reports to be restricted reports. Although restricted reports are not evaluated by the Incident Determination Committee, the victims can still receive treatment planning without the involvement

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of command or law enforcement and these cases are still monitored by the clinical case staff (U.S. DOD, 2021b). It is important to note that the clinical case staff meeting members are different from the Incident Determination Committee members. Clinical case staff meeting membership is limited to individuals with clinical expertise in child maltreatment and DA.  The clinical case staff meeting is chaired by either the installation FAP manager or FAP supervisor of clinical services. Based on the nature of the incident, the clinical case staff meeting chair can invite military and civilian subject matter experts, including medical, behavioral health and social services professionals to discuss treatment recommendations and safety planning for the case. Civilian child protective service professionals can only be invited when child maltreatment incidents are discussed and DA victim advocates can only be invited when DA cases are discussed (U.S. DOD, 2021b).

Fatality Review Boards In the infrequent instances where child maltreatment or DA results in a victim’s death, the DOD requires that each military branch convene a multidisciplinary Fatality Review Board to conduct a comprehensive review of the conditions that led to the death (U.S. DOD, 2017b). In an effort to “avoid interference with ongoing investigations and prosecutions, fatalities are reviewed by the Military Departments retrospectively after the incident disposition has been closed” (U.S. DOD, 2021a, p.  14). Annually, a DOD Fatality Review Summit is held where each military branch’s Fatality Board findings are discussed. More specifically, “The purpose of the DoD Fatality Review Summit is to conduct deliberative examinations of any interventions provided to the deceased or their family, to formulate lessons learned from agency or system failures, to identify trends and patterns to assist in prevention efforts across the Department, and to develop policy for earlier and more effective intervention” (U.S. DOD, 2021a, p. 14).

4 DOD Central Registry The DOD FAP Central Registry consists of all unrestricted “met criteria” FV incident reports submitted to each military service FAP, as required by the DODM 6400.01, Volume 2 (U.S. DOD, 2019c). For “met criteria” incidents, the DOD FAP Central Registry contains information on the types of child maltreatment and DA, severity levels, and fatalities as well as victim and offender demographic information, name, and DOD identifiers. In instances where reports of child maltreatment and DA do not meet criteria, identifying information is not recorded. Further, data on restricted DA reports are not recorded in the DOD FAP Central Registry. A

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detailed discussion of the information elements contained in the DOD FAP Central Registry is available elsewhere (U.S. DOD, 2019c). It is important to mention that the DOD FAP Central Registry does not contain law enforcement data including the legal disposition of FV incidents. Measures of accountability are intentionally kept separate from the clinical FAP data as required by DOD policies (Barna, 2018). However, the DOD Central Registry data are used to provide information on rates and trends of FV in the U.S. military, to inform FAP intervention and prevention efforts, and to identify FV research needs (U.S. DOD, 2021a). In addition, DOD FAP Central Registry data searches are used as part of the military’s background checks on applicants who are seeking employment in DOD-­ sanctioned organizations serving children (U.S. DOD, 2021a).

5 DOD Child Maltreatment and DA Reports and Incident Rates Child Maltreatment Reports and Incident Rates Child maltreatment reports and met criteria rates for the U.S. military for fiscal years 2003 through 2020 are presented in Table 14.2. The U.S. military child maltreatment data were obtained from the annual DOD child abuse and neglect and domestic abuse reports (e.g., U.S.  DOD, 2021a). For comparison purposes, the U.S. general population child maltreatment reports and substantiation rates for fiscal years 2003 through 2019 (the last available data) are presented in Table 14.2. It should be noted that among the U.S. military met criteria incidents reported in Table 14.2, not all of the abusers were the child’s parents. For example, in the most recent fiscal year (2020), the caregiver status of the U.S. Military met criteria incidents was 92.6% parents (49.6% military parents, 43.0% civilian parents) with the remaining caretakers consisting of other family members, extra-familial caregivers, and unknown individuals (U.S. DOD, 2021a, p. 28). The military caretaker percentages are similar to the general population child maltreatment caretaker percentages reported in the most recent fiscal year (2019) where 77.5% of the offending caretakers were parents with the remaining offenders being nonparents or unknown individuals (USDHHS, ACF, ACYF, CB, 2021, p. 75). Based on the data presented in Table  14.2, for the U.S. military, the child maltreatment report rate/1000 children for fiscal years 2003 through 2020 ranged from 11.2/1000 children to 15.7/1000 children (M  =  13.3, SD  =  1.4). The child maltreatment met criteria rate/1000 children for fiscal years 2003 through 2020 ranged from 4.8/1000 children to 7.3/1000 children (M = 6.1, SD = 0.8). The child maltreatment met criteria percentages for the reported child maltreatment cases for fiscal years 2003 through 2020 ranged from 39.2% to 50.4% (M  =  45.6%, SD = 2.7%). For the U.S. general population, the child maltreatment report rate/1000 children for fiscal years 2003 through 2019 ranged from 39.1/1000 children to

1,104,716

1,103,362

1,103,270

1,122,098

1,147,318

1,166,079

1,165,812

1,140,024

1,099,702

1,050,889

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

15.7

14.0

13.7

12.9

12.9

11.2

11.3

12.5

11.4

12.5

7.3

6.4

6.1

5.8

5.7

4.8

4.8

4.9

5.1

5.6

7.0

1,120,590

2004

14.9

U.S. military population (worldwide) Child Total reports Met criteria population rate/10001 rate/10001 1,149,764 14.2 6.5

Fiscal year 2003

46.5

45.7

44.5

45.0

44.2

42.9

42.5

39.2

44.7

44.8

47.0

Met criteria percentage 45.8

U.S. general population Child Total referrals population2 rate/10001,3 35,603,658 39.1 (34) 48,009,547 42.6 (38) 49,569,634 43.9 (39) 51,978.025 43.7 (42) 48,455,968 43.0 (37) 53,420,280 44.1 (41) 59,557,447 43.1 (45) 59,557,447 43.8 (45) 59,153,973 45.8 (45) 63,709,365 46.1 (46) 64,037,380 47.1 (47) 63,889,299 48.8 (46) 9.4

8.9

8.8

9.2

10.4

10.3

10.5

10.8

12.5

12.5

12.3

Substantiation rate/10004,5 12.0

19.3

18.8

19.1

20.0

23.7

23.9

23.7

25.2

28.6

28.5

28.8

Substantiation percentage 30.6

Table 14.2  Child maltreatment reports and met criteria/substantiation rates for the U.S. Military, Fiscal Years 2003 through 2020, and for the U.S. General Population, Fiscal Years 2003 through 2019

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939,186

921,193

917,891

905,577

2017

2018

2019

2020

5.9

6.1

6.5

6.9

49.2

45.2

46.8

50.4

50.0

Met criteria percentage 46.5

U.S. general population Child Total referrals population2 rate/10001,3 59,011,198 53.2 (44) 59,401,029 55.1 (45) 74,312,174 47.1 (52) 73,993,353 47.8 (52) 73,611,681 47.2 (52) 7.9

8.0

8.0

9.5

Substantiation rate/10004,5 9.6

16.7

16.8

17.0

17.2

Substantiation percentage 18.0

Note. U.S. military data for fiscal years 2003 through 2020 were taken from the annual DOD child abuse and neglect and domestic abuse reports (e.g., U.S.  DOD, 2021a). U.S. general population data for fiscal years 2003 through 2019 were taken from the annual HHS Child Maltreatment reports (e.g., USDHHS, ACF, ACYF, CB, 2021). For consistency purposes, the original annual reports were used instead of summaries of past years presented in more recent reports because the data in more recent reports can be slightly different than the data in some of the original reports 1 Total reports/referrals and met criteria/substantiation rates are based on all child maltreatment incidents, not on the unique number of child victims. Although annual U.S. Children’s Bureau Child Maltreatment reports include both total incident rates and non-duplicated victim rates, the military data in this table are based on incidents. So for comparison purposes, the total incident data from the U.S. Child Maltreatment annual reports are presented in this table 2 The most current fiscal year data are for fiscal year 2019. Child population of reporting states; number of reporting states indicated in curved brackets 3 Total referrals include “screened-in” and “screened-out” referrals 4 Reports that received a child protective services’ response 5 Substantiated includes “substantiated,” “indicated,” and “alternative response victim,” but beginning with the Child Maltreatment 2015 report, “alternative response victim” was no longer used to define substantiated cases. So, for fiscal year 2015 and afterward, substantiated incidents only includes “substantiated” and “indicated” U.S. military cases may or may not appear in the U.S. general population data

12.0

13.5

13.9

13.7

7.2

969,058

2016

14.4

U.S. military population (worldwide) Child Total reports Met criteria population rate/10001 rate/10001 1,005,626 15.5 7.2

Fiscal year 2015

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Table 14.3  Domestic abuse rates: spouse abuse reports and intimate partner abuse reports and met criteria incident rates for U.S. military families for fiscal years 2007 through 2020 and fiscal years 2009 through 2020, respectively Spouse abuse in U.S. military families Married couples in Total Met Fiscal U.S. reports criteria year military rate/1000 rate/1000 2007 708,178 21.5 10.2 2008 718,526 22.2 9.4 2009 738,067 24.7 10.1 2010 751,758 25.0 11.2 2011 753,110 25.6 11.1 2012 734,308 25.4 11.4 2013 713,135 24.3 11.1 2014 690,460 23.6 10.8 2015 665,429 23.6 11.9 2016 646,782 23.4 11.8 2017 638,132 24.5 11.2 2018 628,167 24.3 11.2 2019 626,705 21.7 10.9 2020 620,387 20.4 10.6

Intimate partner abuse in U.S. military families1

Met criteria percentage 47.4 42.3 44.9 44.8 43.4 44.9 45.7 45.8 50.4 50.4 45.7 46.1 50.2 52.0

Total reports

Met Met criteria criteria percentage

1415 1539 1662 1718 1866 1870 1798 1771 1519 1670 1902 2026

747 721 867 909 996 69 966 1022 916 1024 1121 1307

52.8 46.8 52.2 52.9 53.4 51.8 53.7 57.7 60.3 61.3 58.9 64.5

Note: The U.S. military Spouse Abuse and Intimate Partner Abuse data were obtained from the annual DOD child abuse and neglect and domestic abuse reports (e.g., U.S. DOD, 2021a). Prior to fiscal year 2015, met criteria incidents may have included multiple maltreatment types in one incident report. Beginning in fiscal year 2015 more than one incident could be reported and meet criteria for an individual victim (U.S. DOD, 2018, p 13). Total reported Intimate Partner Abuse rates/1000 and met criteria rates/1000 are not provided because data are not available for a denominator (i.e., the number of service members in an intimate partner relationship) 1 In fiscal year 2006, DOD added an additional category, “intimate partner,” to capture incidents involving: (1) a former spouse; (2) a person with whom the victim shares a child in common; or (3) a current or former intimate partner with whom the victim shares or has shared a common domicile. In such cases, the victim or the abuser may have been a service member or civilian. However, it was not until fiscal year 2009 that reported and met criteria incidents of Intimate Partner Abuse were separated and included as a distinct category in the DOD annual report of child abuse and neglect and domestic abuse (U.S. DOD, 2018, p. 49)

55.1/1000 children (M  =  46.0, SD  =  3.9). The child maltreatment substantiation rate/1000 children for fiscal years 2003 through 2019 ranged from 7.9/1000 children to 12.5/1000 children (M = 10.0, SD = 1.6). The child maltreatment substantiation percentages for the reported child maltreatment cases for fiscal years 2003 through 2019 ranged from 16.7% to 30.6% (M = 22.1%, SD = 4.8%). There are several notable differences in the military and general population child maltreatment reports and incident rates. For example, across the years studied, the military, compared to the general population, had a mean total reported cases per 1000 children that was lower by a ratio of 1 to 3.5 (M = 13.3, M = 46.0, respectively). In contrast, across the same years, more than twice as many of the child

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maltreatment reports in the military met criteria compared to the number of general population that were substantiated (M  =  45.6%, M  =  22.1%, respectively). Nevertheless, the total number of child met criteria cases/1000 children in the military is only 61% of the number of child maltreatment substantiated cases/1000 children observed in the general population (M = 6.1, M = 10.0, respectively). Further, in the military, the total reported child maltreatment cases per 1000 children, the met criteria child maltreatment rate per 1000 children, and the met criteria percentages were relatively stable during the years studied. In contrast, in the general population, there was a clear trend towards a lower substantiation rate per 1000 children and a lower substantiation percentage across the years studied. Especially noteworthy is the fact that in more recent years, the military child maltreatment met criteria percentages were in the upper 40% range and the general population child maltreatment substantiated percentages were in the 16% to 17% range. Not shown in Table  14.2 are the findings that, in the most recent fiscal year (2020) that data are available (U.S. DOD, 2021a), among all military met criteria reports, 20.77% were child physical abuse incidents, 4.13% child sexual abuse incidents, 13.86% were child emotional abuse incidents, and 61.24% were child neglect incidents (p.  21). Comparison of the military child maltreatment types with the general population data provided in the child maltreatment annual report (USDHHS, ACF, ACYF, CB, 2021) reveals that the biggest difference in the rates for child maltreatment types was for child neglect incidents. Although the child neglect cases are not counted in exactly the same manner, in the most recent years that data are available, the child neglect rates in the general population were 74.9% compared to the military child neglect rates of 61.24% reported above. The reasons for the lower child neglect rates in the U.S. military families are not known. However, one possible explanation is that the economic (e.g., relatively stable income, medical care, and stipends for housing and sustenance) and other supports (e.g., child care and respite care) provided by the military reduce the risk for child neglect in military families. Further, in the most recent DOD annual report (U.S.  DOD, 2021a), the child sexual abuse met criteria incidents per 1000 children showed a statistically significant decrease in child sexual abuse incidents compared to the most recent 10-year average of military child sexual abuse incidents. The reduction of child sexual abuse incidents in the military is similar to reductions in child sexual abuse incidents reported in the general population (Child Trends, 2019; Military Reach Research and Outreach, 2019). Also not shown in Table 14.2 is the fact that in the military in fiscal year 2020 there were 31 child fatalities, which is 31/905,577 or 0.034/1000 children (U.S. DOD, 2021a). In the general population, for the most recent fiscal year (2019) that data are available, there were an estimated 1840 child fatalities or 0.025/1000 children (USDHHS, ACF, ACYF, CB, 2021, pp. 53–54). A striking difference in the fatality data is that in the military 61.3% of the child victims were 1 year of age or younger (U.S. DOD, 2021a, p. 38), whereas in the general population 29.8% of the

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child victims were 1 year of age or younger (USDHHS, ACF, ACYF, CB, 2021, p. 55). However, caution must be used when making comparisons between the military child maltreatment data and the U.S. general population child maltreatment data. First, as previously discussed, the child maltreatment definitions and substantiation processes are different in the military and in the state civilian child protective services agencies on which the two child maltreatment annual reports are based. Second, unlike the military, the general population data do not include all of the reported and substantiated child maltreatment cases because not all states report complete child maltreatment data and, in some cases, where states report child maltreatment data not all counties in the state reported data to the state. Third, when comparing the military and general population data, a major limitation is that the demographics for the U.S. military are different from the demographics of U.S. general population. For example, the U.S. military personnel are mostly (84%) male, are younger, are better educated, and are more often members of the middle class than individuals in the general population (Council on Foreign Relations, 2020). Further, there appear to be different FV risk and protective factors in the military and general population groups, which will be discussed later in this chapter. Finally, a limitation of all child maltreatment registry data, which may differentially impact the military and general population child maltreatment registry data, is that they represent only a subset of the child maltreatment that has occurred annually because many, if not most, child maltreatment incidents are not reported (e.g., Flaherty et al., 2008; Sedlak et al., 2010).

DA Reports and Incident Rates The Spouse Abuse and Intimate Partner Abuse reports and the associated met criteria incident rates for U.S. military families for fiscal years 2007 through 2020 and for fiscal years 2009 through 2020, respectively, are presented in Table 14.3. For the U.S. military, the Spouse Abuse report rate/1000 married couples for fiscal years 2007 through 2020 ranged from 20.4/1000 married couples to 25.6/1000 married couples (M  =  23.6, SD  =  1.6). The Spouse Abuse met criteria rate/1000 married couples for fiscal years 2007 through 2020 ranged from 9.4/1000 married couples to 11.9/1000 married couples (M = 10.9, SD = 0.7). The met criteria percentages for reported DA cases for fiscal years 2007 through 2020 ranged from 42.3% to 52.0% (M = 47.7%, SD = 2.9%), indicating that overall almost one-half of all the military DA reports met criteria. For the U.S. military, the Intimate Partner Abuse annual reports for fiscal years 2009 through 2020 ranged from 1415 to 2026 (M = 1729.7, SD = 178.4) reports. The Intimate Partner Abuse number of met criteria cases for fiscal years 2009 through 2020 ranged from 721 to 1307 (M  =  963.8, SD  =  157.0). The Intimate Partner Abuse met criteria percentages for reported cases for fiscal years 2009 through 2020 ranged from 46.8% to 64.5% (M = 55.5%, SD = 5.0%), indicating that

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across the period more than half of all Intimate Partner Abuse reports were judged to have met criteria; a higher proportion than for DA. Although the U.S. military tracks the number of married couples, currently there are no data on the number of U.S. military service members who are in an intimate partner relationship as defined by DOD (U.S. DOD, 2018, p. 49). Therefore, it is not possible to calculate Intimate Partner Abuse rates per 1000 intimate partners. Further, for both Spouse Abuse and Intimate Partner Abuse, there are no general population Spouse Abuse and Intimate Partner Abuse data that can be used for comparison purposes.

6 Putative Military-Specific FV Risk and Protective Factors In addition to FV risk factors experienced by general population families (e.g., Milner et al., 2021; Stith et al., 2009), military families often experience military-­ specific factors that may influence FV risk. For example, active duty members experience the stress of being responsive 24/7 to the needs of the military (Gibbs et al., 2011; Milner, 2015), including changes in job assignments, some of which require involuntary relocation (Borden et al., 2017; Gibbs et al., 2011; Milner, 2015). When military families move, not only can relocation involve establishing a new residence, family members must establish new support systems (Milner, 2015). In addition to the stress of family relocations, active duty members may experience separations from their families due to military assignments, such as duty obligations, training, peacekeeping, and combat deployments (e.g. Gibbs et  al., 2011; Milner, 2015). Following an active duty member’s separation from their family, the family may experience reintegration challenges and related stress (e.g., Military Reach Team, 2015). In contrast, there are military-specific factors that may be related to a reduction of FV risk. For example, when seeking to enter the military, applicants are screened for mental health problems, illicit drug use, and criminal histories (e.g., Bray et al., 2010), which if present can preclude their entry into military service. Compared to families in the general population, military couples are better educated, more likely to be married, more likely to live in two-parent families, and have lower rates of illicit drug use (e.g., Clever & Segal, 2013). Compared to civilian families, military families have greater access to healthcare and tend to have stable incomes, although civilian spouses appear to be underemployed (Hosek & Wadsworth, 2013). In addition, military families have access to many installation-based support services, such as childcare and parenting programs (Clever & Segal, 2013; Milner, 2015) that may reduce FV risk. This list of military-specific FV risk and protective factors is not exhaustive. Further, additional research is needed to determine the extent to which there are other potential military-specific risk and protective factors and how they contribute to FV both individually and in their interactions. Such research is important because

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it has the potential to inform FV treatment and prevention efforts specific to military families.

7 DOD FAP FV Treatment and Prevention Efforts Military FAP has developed programs that focus on the tertiary, secondary, and primary prevention of FV. As previously discussed, once the Incident Determination Committee makes a status determination that a child maltreatment or DA report meets criteria, the case is referred to the FAP clinical case staff meeting, which develops a coordinated treatment plan. Further, in FV safety planning a goal is to collaborate with state and local civilian social services and law enforcement agencies to provide a coordinated community response and support for service members and their families (Robertson, 2014). Military FAP tertiary FV treatment options include a wide array of clinical interventions for victims, perpetrators, and other family members that use a variety of treatment modalities (e.g., see Farris et al., 2019 for a list of FAP clinical interventions). Supplementing treatment, a relatively unique military support program for female and male DA victims, is a service-wide Domestic Abuse Victim Advocates (DAVA) Program. Trained victim advocates (referred to as DAVAs) provide DA victims with information about available services for the victim and any children and provide non-clinical DA victim support services. More specifically, in military families when a female or male DA victim desires assistance, DAVAs are available 24/7 to provide support services. When requested by the DA victim, DAVA services include, but are not limited to, helping victims develop and maintain a safety plan and develop an action plan with short- and long-terms goals. In addition, DAVAs can accompany victims to appointments, including military and civilian court proceedings. DAVAs can inform DA victims about available services (for the victim and any children) and information on gaining access to such services (U.S. DOD, 2017b). Beyond tertiary FV interventions and support services, military FAP provides secondary FV prevention programs. For example, a major service-wide secondary FV prevention program is called the New Parent Support Program (U.S.  DOD, 2020). The New Parent Support Program is a voluntary home-visiting program designed to provide information and support for expectant and new parents who screen at risk for FV. The New Parent Support Program goals include assisting in the management of pregnancy, establishing healthy relationships between caretakers and their children, helping caretakers manage the demands of parenting, and building caretaker support networks (U.S. DOD, 2020). In addition, although there is variation among installations in the programs offered (Farris et al., 2019), FAP engages in numerous primary prevention and outreach efforts, which include counseling services for individuals and couples as well as workshops and classes in a variety of topics (e.g., anger management, stress management, relationship enhancement, parenting skills, and life skills; e.g., Milner,

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2015; Travis et  al., 2015). FAP primary prevention efforts also include outreach programs that provide briefings and training for base personnel on all forms of FV prevention (e.g., DOD, 2019; Travis et  al., 2015). Outreach programs focus on improving FAP client engagement strategies, especially with young military families, while increasing individual self-evaluating and help-seeking behaviors (e.g., DOD, 2019).

8 DOD FV Research, Reviews, and Programmatic Development Although not widely recognized, for several decades, military FAP has been actively involved in conducting applied research. Importantly, the extensive service-specific repositories documenting FV reports and the DOD Central Registry provide a rich data resource, and DOD policy directs the use of these data to analyze trends that would inform policy and practice (U.S. DOD, 2016). The U.S military has facilitated important secondary analyses of these data bases for decades in an effort to better understand patterns of FV among military families and to inform policy and practice. For instance, FAP supported the first population-based research on the impact of deployment on child maltreatment rates (Rabenhorst et al., 2015; Thomsen et al., 2014) and Spouse Abuse rates (Rabenhorst et al., 2013, 2012) among active duty military personnel. FAP has also studied risk factors for child abuse and child neglect fatalities (Brewster et al., 1998; Lucas et al., 2002); temporal variations in military Intimate Partner Abuse (McCarthy et al., 2014, 2016), who reports FV (i.e., military referral sources; Linkh et al., 2008), factors associated with Intimate Partner Abuse (Stander et al., 2021) and Intimate Partner Abuse recidivism in the military (Coley et al., 2016; McCarthy et al., 2018), and family risk factors associated with different child neglect types in the military (Cozza et al., 2019). The service and DOD FAPs have long records for conducting integrated program development and evaluation based on empirical research and pilot testing. We describe a few of these programmatic efforts below in order to provide an indication of the breadth and scope of the types of FAP projects that have been conducted. The examples also highlight the extent to which research, policy, and practice have been integrated. As previously mentioned, one of the best examples of applied empirical research conducted through DOD FAP is the development of standardized child maltreatment and DA definitions for the U.S. military and the design of a computer-based algorithm (The Decision Tree Algorithm) that is used by Incident Determination Committees (e.g., Heyman et  al., 2010; Heyman & Slep, 2006, 2009: Slep & Heyman, 2006). As a result, military installations worldwide now have a standard method for determining if reported FV incidents meet definitional criteria (U.S. DOD, 2021b). Importantly, the decision tree process was designed to increase reliability and reduce potential biases in child maltreatment and DA substantiation

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decision-making. Evaluations of the system suggest that since the new algorithm was implemented, met criteria events have been characterized by greater incident severity and substance use, but not with the demographic characteristics of the alleged offender (e.g., age, gender, military status; Travis et al., 2015). Further, the development of the standard military FV definitions has influenced the conceptualization of FV in the civilian sector. For example, the military child maltreatment definitions were used as the basis for the child maltreatment criteria in the Diagnostic and Statistical Manual Fifth Edition (American Psychiatric Association, 2013) and in the International Classification of Disease 11th Revision (World Health Organization, 2018; A. Slep, [aka A. Smith], personal communication, September, 27, 2021). The military child maltreatment definitions are also being considered for use by the state of Alaska (A. Slep [aka A. Smith], personal communication, September, 27, 2021). In another example, extensive work has been conducted to develop an empirically based, military-specific Family Needs Screener, a tool used to categorize the FV risk level for entry into secondary prevention programs like the New Parent Support Program (Kantor & Straus, 1999; Kaye et al., 2019; McCarthy et al., 2020; Travis et al., 2015). The military has also developed an empirically-based, military-­specific screening tool (i.e., the Intimate Partner Physical Abuse  – Risk Assessment Tool (IPPI-RAT) that provides an assessment of future risk of physical injury in reported cases of DA (Stith et  al., 2016). Elevated scores on the IPPI-RAT provide an assessment of the need for safety planning and are used at installations worldwide. The results of many recent FAP program evaluations are described in the most recent DOD annual child abuse and neglect and domestic abuse report (U.S. DOD, 2021a). For example, for the past several years Air Force FAP service providers have used a client feedback form in all FV intervention and secondary prevention programs. Results from the program evaluation data collected with this form for fiscal years 2015 through 2019 revealed significant improvements in client well-­ being for multiple FV interventions, such as the New Parent Support Program. For fiscal years 2018 through 2019, the Air Force also found significant improvements in client well-being in their Change Step (for male offenders), and Vista (for female offenders) DA treatment programs. In addition, program reviews inform DOD FAP training and prevention programs. During fiscal year 2020, the Office of the Secretary of Defense conducted a DOD wide review of FV prevention activities. For example, one product of this review was “the development of a new logic model, based on the evidence-informed approaches to domestic abuse and child abuse and neglect recommended by the Centers for Disease Control (CDC), that have been adapted to the military community context” (U.S. DOD, 2021a, p. 69). A comprehensive list of ongoing DOD FAP initiatives can be found in the most recent DOD annual report on child maltreatment and DA rates (U.S. DOD, 2021a). At about the same time, in 2020, the U.S. Government Accountability Office was tasked to conduct a review of DOD FAP Central Registry data collection procedures and issued a report that contained 23 recommendations. These recommendations focus on improving DOD FAPs tracking and response to reports of child maltreatment

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(U.S.  Government Accountability Office, 2020). Included in the Government Accountability Office’s report are DOD’s responses to each recommendation. Also included in the report are planned implementation steps and timelines. Another recent Government Accountability Office report focused on DA and made 32 recommendations designed to enhance DOD FAPs DA tracking, treatment, and prevention services (U.S.  Government Accountability Office, 2021). Internal and external reviews such as these, integrated with targeted recommendations and programmatic adaptation, contribute to an ongoing process of improvement across DOD Family Advocacy Program institutions (e.g., National Academies of Sciences, Engineering, and Medicine, 2019).

9 Summary As evidenced by the description of some of the DOD FAP activities provided in this chapter, and in contrast to the old adage “if the military had wanted you to have a family, it would have issued you one” (Milner, 2015), the past three decades of programmatic data and innovative initiatives are indication of the U.S. military’s commitment to promoting healthy military families. Significant efforts have been made to define and determine incidents of FV, to improve community response to safety planning, and to deliver quality treatment and prevention services to military families. Further, given the current initiatives, it is clear that the DOD FAP services are not static and that the DOD FAP’s commitment to improving FAP services and supporting military families will continue.

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U.S. Department of Defense. (2019b). Department of Defense Manual 6400.01, Volume 1, Family Advocacy Program (FAP): FAP Standards. https://www.esd.whs.mil/Portals/54/Documents/ DD/issuances/dodm/640001m_vol1.pdf?ver=2019-­07-­22-­100753-­203 U.S.  Department of Defense. (2019c). U.S.  Department of Defense Manual 6400.01, Volume 2, (2019, July). Family Advocacy Program (FAP): Child abuse and domestic abuse incident reporting system. https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/ dodm/640001m_vol2.pdf U.S.  Department of Defense. (2020). Department of Defense Instruction 6400.05, New Parent Support Program (NPSP). https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/ dodi/640005p.pdf U.S. Department of Defense. (2021a). Department of Defense: Report on child abuse and neglect and domestic abuse in the military for Fiscal Year, 2020. https://download.militaryonesource. mil/12038/MOS/Reports/FINAL-­DoD-­FAP-­Report-­FY2020.pdf U.S. Department of Defense. (2021b). Department of Defense Manual 6400.01, Volume 3, Family Advocacy Program (FAP): Clinical Case Staff Meeting (CCSM) and Incident Determination Committee (IDC). https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/ dodm/640001m_vol03.PDF?ver=VlHGJ0kCCGuApm21-­C7pNQ%3D%3D U.S.  Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2021). Child maltreatment 2019. https://www.acf.hhs.gov/cb/report/child-­maltreatment-­2019 U.S. Department of Health and Human Services. (2019). Definitions of child abuse and neglect. https://www.childwelfare.gov/pubPDFs/define.pdf U.S.  Government Accountability Office. (2020). Child welfare: Increased guidance and collaboration needed to improve DOD’s tracking and response to child abuse. https://www. gao.gov/products/gao-­20-­110 U.S.  Government Accountability Office. (2021). Domestic abuse: Actions needed to enhance DOD’s prevention, response, and oversight. https://www.gao.gov/assets/gao-­21-­289.pdf William M. (Mac) Thornberry National Defense Authorization Act for Fiscal Year 2021. Pub. L. No. 116-283, § 549B, 235. (2021). World Health Organization. (2018). International classification of diseases for mortality and morbidity statistics (11th Revision). Author. https://icd.who.int/browse11/l-­m/en. World Health Organization. (2020a). Violence against children. Author. https://www.who. int/news-room/fact-sheets/detail/violence-against-children World Health Organization. (2020b). Violence against women. Author. https://www.who.int/ news-­room/fact-­sheets/detail/violence-­against-­women

Chapter 15

Mindfulness and Family Aggression and Violence Nirbhay N. Singh , Giulio E. Lancioni Oleg N. Medvedev , Yoon-Suk Hwang

, Rebecca Y. M. Cheung , and Rachel E. Myers

,

Family units are complex social systems in which interactions among members influence each other’s behavior. Indeed, changes in one member of the family are likely to influence the entire family social system and, over time, may lead to changes in the behavior of other members (Priest, 2021). Families engage in self-­ regulation (e.g., stabilizing interaction patterns following disruption) and self-­ reorganization (e.g., in family dynamics) as their circumstances change (Cox & Paley, 2003). Although there has been a tendency to develop and use a variety of interventions for individuals within families who engage in aggression and violence, particularly for children and adolescents, family systems theories suggest that

N. N. Singh (*) Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA, USA G. E. Lancioni Department of Neuroscience and Sense Organs, University of Bari, Bari, Italy e-mail: [email protected] R. Y. M. Cheung Department of Early Childhood Education, The Education University of Hong Kong, Ting Kok, Hong Kong e-mail: [email protected] O. N. Medvedev School of Psychology, University of Waikato, Hamilton, New Zealand e-mail: [email protected] Y.-S. Hwang Centre for Disability Studies, University of Sydney, Camperdown, NSW, Australia R. E. Myers WellStar School of Nursing, Kennesaw State University, Kennesaw, GA, USA e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 P. Sturmey (ed.), Violence in Families, Advances in Preventing and Treating Violence and Aggression, https://doi.org/10.1007/978-3-031-31549-7_15

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there is good reason for such efforts to be directed at family-based interventions (Carr, 2020). A number of psychosocial interventions have been developed for families with children who have behavioral and emotional problems or have been exposed to domestic violence. For example, Parent–Child Interaction Therapy is an evidence-­ based program for families whose children have externalizing behavior problems although Parent–Child Interaction Therapy appears to be effective for internalizing problems as well (Phillips & Mychailyszn, 2021). The ACT Raising Safe Kids Program (Silva, 2009), developed by the American Psychological Association, and the Triple P-Positive Parenting Program (Sanders et al., 2014) are universal violence prevention parenting programs that focus on enhancing the quality of parent–child relationships. The Triple P program is an evidence-based program that has been extensively researched (Prinz, 2020) and, although the ACT Program is less well established, a recent systematic review indicated it provides a promising approach to family violence prevention (Pontes et al., 2019). The Incredible Years parenting program is a social learning theory-based program that has been widely evaluated and found to be effective in reducing conduct problems of children and enhancing positive parenting qualities in their parents (Gardner & Leijten, 2017). Mindfulness offers an alternative mode for understanding and intervening to ameliorate unskillful interactions in family systems. The classic work in this area by Kabat-Zinn and Kabat-Zinn (1997) on mindful parenting provided the experiential, philosophical, and theoretical foundations, but the first experimental studies (i.e., Singh et al., 2006, 2007) did not appear until almost a decade later. The early experimental studies were based on single-case experimental designs, but later studies used quasi-experimental designs and randomized controlled trials for assessing the effects of mindful parenting on the parents’ and their children’s behaviors (see Singh & Singh Joy, 2021 for reviews). In this chapter, we briefly introduce mindfulness and mindfulness-based interventions (MBIs) for family members with aggressive and other externalizing behaviors. We present current limitations and suggestions for future research on aggression management in families. Finally, we present an illustrative case study demonstrating how a specific MBI can be used within family systems, beyond dyadic interactions of parents and their children, to positively influence family systems.

1 Mindfulness Mindfulness is somewhat of an elusive concept in the sense that it can be and has been defined in different ways depending on the context in which it is used (Amaro & Singh, 2021). Kabat-Zinn (1994) provided one of the more commonly used definitions in terms of the awareness that arises through “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” (p. 4). An operational definition proposed by Bishop et al. (2004) has it as “[A] kind of nonelaborative,

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nonjudgmental, present-centered awareness in which each thought, feeling, or sensation that arises in the attention field is acknowledged and accepted as it is” (p. 232). While neither provides an objectively measurable set of actions or behaviors, the effects of mindfulness can be measured reliably. In essence, because mindfulness is experiential, it can be construed as the art of living in the present moment, on purpose, and without judgment of whatever unfolds in each moment. As noted by Munindra (Knaster, 2010, p. 1), “It is actually an education in how to see, how to hear, how to smell, how to eat, how to drink, how to walk with full awareness.” The majority of MBIs offer various ways of integrating mindfulness in one’s life through meditation. Mindfulness meditation as espoused in MBIs is often thought of as two separate modes of meditation, consisting of tranquility and insight, although in early Buddhist discourses they were considered to be complementary qualities of meditation (Anālayo, 2020, p. 115). Tranquility or concentration meditation is known as focused attention (FA) meditation (Lutz et  al., 2015) in western mindfulness research. FA requires an exclusive focus on a specific object of meditation, often one’s breath, to the exclusion of everything else. This results in stabilizing one’s attention in the present moment and, when other objects in the mindfulness practitioner’s sensorium intrude, such as thoughts, or when the mind wanders, attention is refocused on the breath. In effect, one monitors or has meta-awareness of the quality of attention on the breath. Insight meditation, also known as open monitoring (OM) meditation, usually follows when stability of attention in the present moment is achieved through FA. In OM meditation, the focus shifts from observing the breath to monitoring awareness itself, with attention being directed to whatever arises as each moment unfolds, without focusing on anything in particular. In time, OM practice leads to achieving deeper insights into the nature of the mind, such as impermanence, not-self, and disease or suffering (Lutz et al., 2007). The process of MBIs generally begins with mindfulness meditation. This leads to the establishment of attention and awareness, and acceptance of what unfolds in successive moments. MBIs assist the mindfulness practitioner to develop these skills through a number of specific meditations depending on the context of self-­ care, such as pain management, stress reduction, anxiety, worry, or challenging family interactions, including aggression and violence. When the meditation practice is well-established, changes in daily life occur which lead to lifestyle changes that are maintained and generalized across contexts and conditions. If the practitioner has aspirations that are in addition to or beyond physical and mental self-care, the focus of the practice shifts to a spiritual realm. Figure 15.1 presents an explanatory model of this process in cognitive behavioral terms.

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Fig. 15.1  An illustrative example of the flow of a mindfulness-based intervention

2 Family Interventions Data from correlational studies have pointed to associations between mindfulness and likely variables that may mediate change processes in family systems. For example, research suggests that disagreements and minor conflicts in family interactions could lead to major family disharmony, perhaps resulting in aggression and violence, or alternatively to cohesiveness with mindful compassionate and accepting response. For example, in a sample of parents involving male post-­ deployed military service members and their female non-deployed partners (Zhang et  al., 2020), parents’ nonreactivity was related to their own anger observed in a conflict interaction. That is, fathers and mothers who allowed experiences to occur without reacting to them also had a lower level of observed anger. In addition, mothers’ nonreactivity was related to fathers’ lower anger, thereby suggesting mother-to-­ father partner-effects. In another cross-sectional study involving married couples

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(Wachs & Cordova, 2007), mindful awareness was associated with marital quality. In addition, the relationship was mediated by anger reactivity as well as identification and communication of emotional states. Nonreactivity is a component of mindfulness that has emerged as a major correlate of child maltreatment. For example, a longitudinal study by Calvete et al. (2021) found mindful discipline (e.g., involving greater parenting awareness and nonreactivity) to be a predictor of lower levels of adolescents’ aggression, victimization, and depressive symptoms a year later. Two general formats have been used to deliver MBIs for parent–child interactions during conflictual situations. The first is indirectly, which involves a skilled mindfulness trainer providing training to the mother with the hope that her embodied mindfulness will cascade or spillover (Burgdorf et al., 2019; Singh & Hwang, 2021) to other members of the family. In this kind of intervention, the effects of training one or both parents are measured in terms of parental ratings or the observed behavior of the target child. The second is directly, which involves a parent who has been trained in mindfulness or on a specific intervention program providing the mindfulness-based training to their child.

Indirect Effects of Mindful Parenting In the first study designed specifically to assess the spillover effects of parent mindfulness training on their children’s behavior in the absence of additional training for the children, Singh et al. (2006) provided a 12-week mindful parenting course to mothers of children with autism. The mindful parenting course did not include any reference to how the parents could manage the behavior of their children. Observations of the children’s behavior over the course of the 80-week study showed that when compared to baseline observations, the children’s aggression, non-compliance, and self-injury decreased substantially to near-zero rates. These behaviors were targeted for observation because they negatively affected the family dynamics. In a systematic replication, Singh et al. (2007) used the 12-week mindful parenting course with mothers of children with developmental disabilities. When compared to baseline observations, the children’s aggressive behavior decreased to zero or near-zero levels during the course of the study. In terms of family functioning, the children were observed to substantially increase positive social interactions and decrease negative social interactions with their siblings. Furthermore, the mothers’ self-ratings of perceived psychological stress significantly decreased and their satisfaction with their parenting and mother–child interactions increased, suggesting improved family functioning. In further development of the mindful parenting program used in the above studies, the 12-week course was tested and refined into a Mindfulness-Based Positive Behavior Support (MBPBS) stepped care program that included several training options, with 1-day, 3-day, 5-day, and 7-day courses, depending on the needs of families, caregivers, and teachers (Singh et al., 2020). Singh et al. (2019) assessed spillover effects in a controlled trial using the 3-day MBPBS program with

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mothers of children with either autism (n = 47) or intellectual disabilities (n = 45). When compared to baseline levels, both groups of children exhibited significantly less aggressive and disruptive behavior, suggesting that similar levels of behavior change may occur with the 3-day MBPBS program regardless of whether the children are diagnosed with autism or intellectual disabilities. Furthermore, in a three-arm randomized controlled trial, the effects of teaching mothers the 3-day MBPBS program, the mindfulness program alone, and the PBS program alone (n = 65 in each condition) were assessed on the children’s behavior (Singh et al., 2021). While it was expected that the MBPBS and PBS conditions would impact the children’s behavior because these components included specific instruction on behavior change, the mindfulness alone condition produced spillover effects on the children that was less than the full MBPBS program but more than the PBS alone condition, replicating the findings from earlier studies that did not include any behavioral components. In another series of studies, parents participated in an 8-week mindful parenting course, which was based on the Mindfulness-Based Stress Reduction (MBSR; Kabat-Zinn, 1990) and Mindfulness-Based Cognitive Therapy (MBCT; Segal et al., 2002) programs, and then self-rated outcomes in terms of parental psychopathology as well as their children’s psychopathology (who were not included in the training) at pretest, post-test, and follow-up. Of interest is the spillover effects of the mindful parenting training on the children’s externalizing behavior which typically impacts family functioning. In the first study, Bögels et al. (2014) enrolled parents (n = 86) who were referred for training because of their children’s and/or their own psychopathology, or parent–child relationship problems. When compared to pretest ratings, the children’s externalizing behavior on the Child Behavior Checklist (CBCL; Achenbach, 1991a) decreased at post-test immediately following the training of their parents and decreased further following the 8-week follow-up. The effect size was small but significant. This study was directly replicated in a multicenter study (Meppelink et al., 2016), with parents (n = 70) being referred to the study by their family physician because of their child’s psychopathology. The findings were similar to the previous study, with significant reduction in the children’s externalizing behavior, and again with a small effect size. In a large study (n = 247) using the same methodology as in previous studies, Potharst et al. (2021) compared outcomes for parents and children from clinical and non-clinical settings. The results were essentially similar for children from non-clinical settings for child behavior problems, but not for those from clinical settings. Finally, in a two-phase study, Hwang et al. (2015) provided another example of the likely additive effects of parent mindfulness and child mindfulness, with the mother being trained first followed by the mother teaching mindfulness to her child. When the mothers alone were trained in the theory and practice of mindfulness meditation in an 8-week mindfulness program in the first phase, they reported enhanced parental mindfulness, reduced parental stress, and increased quality of family life. The spillover effects on their children included reduced aggressive behaviors and attention problems. In addition, the effects on the children were strengthened when the mothers taught mindfulness meditation to their children in

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the second phase of the study. In effect, this study presented data on the combined effects of indirect and direct effects of mindful parenting. In sum, these studies indicated that training parents in mindful parenting produces spillover effects on their children’s externalizing behavior, which in turn may improve family functioning. However, not all mindful parenting studies produce spillover effects on the children (e.g., Jones et al., 2018; Lo et al., 2017) and there is a need to determine which MBIs do so and under what conditions.

Direct Effects of Mindful Parenting A few studies have reported on the utility of having the children’s parents provide the intervention to help their children self-manage their aggression and disruptive behavior. All of these studies used the Soles of the Feet (SoF) meditation program (Felver & Singh, 2020; Singh et al., 2011c). The SoF is an evidence-based manualized MBI that has been implemented with participants across the lifespan and neurodiversity and has demonstrated high acceptability and fidelity of implementation across multiple settings and contexts (see Felver et al., 2022, for a meta-analysis). In brief, the SoF meditation requires an individual to (a) recognize the antecedent variables that lead to their aggressive or disruptive behavior, (b) disengage their attention from those precursors, (c) reorient their attention to a neutral point on the body, thereby discontinuing the escalation of the challenging behavior, and (d) return calmly to the ongoing activity. The SoF meditation encourages individuals to practice their newly acquired skills in different contexts, thereby supporting generalization across settings once fluency in using it has been achieved (Felver & Singh, 2020; Singh et al., 2011c). In the first study to use SoF in the context of family aggression, Singh et  al. (2011b) taught the mothers of three adolescents with Asperger syndrome to use the SoF meditation in their own lives for any negative emotionally arousing situation, such as rising anger. Once the mothers achieved fluency in using the SoF meditation, they used verbal instructions and modeling to teach the SoF meditation to their adolescents during 15-min sessions on five consecutive days. They encouraged their adolescents to use the meditation when they anticipated anger and aggression and provided them with an audiotape of the instructions they could use for self-practice. The adolescents practiced the meditation with their mothers twice a day and whenever an incident occurred that could elicit aggressive behavior. The adolescents continued to use the procedure until they had three consecutive weeks of no aggressive behavior. Thereafter, their aggressive behavior was monitored for four consecutive years. Results showed that the adolescents were able to achieve total control of their aggressive behavior toward their parents and siblings within 25 weeks of training and were able to maintain the behavioral gains during the 4-year follow-up period. In a related study, Singh et al. (2011a) systematically replicated the methodology of the above study with three adolescents with autism. The differences between the two studies included the diagnosis of the participants (autism vs. Asperger

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syndrome), their ability levels (lower ability in the adolescents with autism), the length of training sessions (30-min per session vs. 15-min), and the length of the follow-up (3 years vs. 4 years). In all other respects the methodology was the same. Results were similar, but low levels of aggression were observed during the 3-year follow-­up with adolescents with autism. In a third study, Singh et al. (2017) taught both parents of three adolescents with Prader–Willi syndrome to use the SoF meditation who then taught it to their adolescents. Functional assessment indicated that the adolescents’ aggression was precipitated when they were denied tangibles (i.e., unlimited access to food). The adolescents engaged in both verbal and physical aggression directed at their parents. Results showed that the adolescents with Prader–Willi syndrome were able to reduce their physical aggression to zero levels and verbal aggression to zero or near-zero levels. Furthermore, they were able to maintain their behavioral gains at about the same levels during the 12-month follow-up. In the most recent study, Ahemaitijiang et al. (2020) extended the methodology and evidence base of the utility of SoF to Chinese adolescents and evaluated the social validity of the program in a Chinese cultural context. The participants were three adolescents who presented with mild levels of autistic behavior and engaged in verbal aggression, physical aggression, and destructive behaviors. The mothers of the adolescents were first taught a foundational meditation practice (i.e., FA meditation) to ensure that they engaged in personal daily meditation, which they practiced for 20-min a day for 4 weeks before they were taught the SoF meditation to fluency. The mothers then taught their adolescents the SoF meditation over a 3-week period for a total of 1.75 hours. Data were collected for 40 weeks with a 1-year follow-up. Verbal aggression and destructive behavior were substantially reduced across all participants and maintained at low levels during the follow-up period. Physical aggression was reduced to zero and maintained at this level during the follow-up. The mothers highly rated the SoF meditation in terms of acceptability, effectiveness, and unintended side effects suggesting the program may be culturally valid for Chinese participants. These studies are suggestive of the effects of direct training of adolescents in the self-management of aggression toward family members. The long-term follow-up data are indicative of lasting maintenance effects. The use of parents as instructors of the MBI is a strength because it enables them to redirect the family dynamics on to a more positive pathway.

Parallel Training in Mindfulness There have been a number of studies that have provided training on MBIs to parents and their children in parallel; that is, mindfulness-based training is provided simultaneously to parents and their children in separate groups (Xie, 2021). While most of these studies investigated the effects of parent–child parallel interventions on general family functioning, parent mental health, and child mental health, a few

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included indices of aggression in the family arising from the behavior of one of the children. In the earliest study, Bögels et al. (2008) used an MBI based on MBCT that was adapted for parents and separately for adolescents. Training was provided in parallel groups of 6 parents and 7 children, for 1.5 hours per weekly session over 8 weeks. Among other measures, the parents rated their children’s behavior on the CBCL and the adolescents rated their own behavior on the Youth Self Report scale (Achenbach, 1991b), with both rating scales including measures of delinquency and aggression. Both parent ratings and child self-ratings showed significant improvement in the adolescents’ externalizing behaviors following the MBI training and the improvements were maintained during the 8-week follow-up period, with large effect sizes. Although a limitation of the study was that it lacked an active control condition, it did indicate an adapted MBCT program may be a promising approach for teaching adolescents to self-manage their aggression. The methodology of this study was replicated and extended by Van der Oord et al. (2012) in a study with children with attention deficit hyperactivity disorder (ADHD) and their parents. The MBI used in the Bögels et  al. (2008) study was manualized and training was provided in parallel groups to parents and their 8- to 12-year-old children for 1.5 hours per week for 8 weeks. Among other measures, parent and teacher ratings of the children’s behavior were obtained on the Disruptive Behavior Disorder Rating Scale (Pelham et al., 1992). On the oppositional defiant disorder sub-scale, neither the parent nor the teacher ratings showed significant changes due to the MBI although changes in other indices (e.g., inattention, hyperactivity/inattention) were evident. In a second replication and extension of the Bögels et  al. (2008) methodology, van de Weijer-Bergsma et  al. (2012) used the same MBI with parents and their 11- to 15-year-old adolescents with ADHD. This was a quasi-experimental study, with a pretest, post-test, and follow-ups at 8 and 16  weeks. Rating scale data for the adolescents’ behavioral regulation (i.e., rule breaking behavior and aggressive behavior on CBCL and the Teacher Report Form (Achenbach & Rescorla, 2001) were obtained from fathers, mothers, and tutors. The data were mixed with significant changes due to the MBI on several variables but in terms of family disharmony only the fathers rated the adolescents’ problem behaviors as improving at the 8-week follow-up. In an independent replication of the above studies, Haydicky et  al. (2015) evaluated the effects of the program (now called the “MYmind” program) in terms of an array of variables, including family functioning and the adolescents’ externalizing behavior. Adolescents with ADHD (n = 18) and their parents (n = 17) attended parallel training sessions and completed rating scales at four time points. Results showed no effects of the MBI on family functioning in terms of the number or intensity of conflicts as reported by the parents or the adolescents. However, the adolescents’ conduct problems decreased post-MBI intervention and this decrease was maintained at the 6-week follow-up. In another parallel training study of parents and their children with ADHD, Lo et al. (2020) reported reductions in the children’s aggression on the CBCL. This study examined the effects of a customized

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family-based mindfulness intervention for the parents, but used a child mindfulness program by Snel (2014) that was unrelated to the parents’ program. In the most recent study, Bögels et  al. (2021) undertook a large (n  =  167) pragmatic quasi-experimental waitlist trial with an 8-week and 1-year follow-up. MYmind was used in parallel training with parents and their 7- to 19-year-old children with ADHD.  Among other findings, when compared to the pretest, the children’s externalizing behaviors showed a significant reduction following the intervention, with the initial small effect size at post-test progressively increasing with the 8-week and 1-year follow-up. While pragmatic trials have certain methodological limitations, the accumulated data thus far suggest that parallel training of parents and their children with externalizing problems may lead to significant reductions in the children’s behavioral problems which affect family functioning. In sum, there is emerging evidence that training parents and their children in MBIs in parallel groups offers a unique way of changing the well-being of both parents and children simultaneously. When considered in the broader context beyond family aggression and violence, MBIs used in parallel training show small positive effects on family functioning, parental mental health, and child mental health (Xie, 2021). Further investigations of this methodology appear warranted.

3 Strengths, Limitations, and Future Research Current research suggests that MBIs may be useful in changing family dynamics affected by aggression and violence. While the empirical evidence is still emerging, there are positive signs that the spillover effects of training parents alone have a measurable effect on the externalizing behavior of their children, which in turn affect family dynamics. Stronger evidence for similar positive effects comes from studies of parents teaching their children and adolescents to use SoF to self-manage their aggressive and destructive behaviors. Furthermore, providing training to parents and their children in parallel is also strongly suggestive of positively affecting family dynamics. The data come from studies that include single-case designs, large quasi-experimental studies, and randomized controlled trials. Also, the participants included children and adolescents across a wide range in terms of age, diagnoses, race, and sex. Given these studies are in an area of research that is relatively new, there are obvious limitations as well. The evidence base is not well established because the effect sizes are small to medium, with some studies showing limited effects. The research studies come from a small group of investigators and have not been replicated by a broad range of researchers with different groups of participants, across cultures, and MBIs. Many MBIs used in this research (e.g., adapted MBCT, MBPBS, MYmind, Mindfulness-Based Well-Being for Parents [MBWB-P], Family-Based Mindfulness Intervention [FBMI]) are modeled after the MBSR 8-week program that is lengthy and demanding of time and effort, which many families in need of mindful parenting do not have. Thus, simpler MBIs may be needed, or at least

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simpler versions of standard programs may need to be developed to meet the needs of such families. For example, the stepped-care model used in MBPBS program provides one option for individualizing the MBI to meet the differential needs of a variety of families and other caregivers. An important consideration is the format used in current research to deliver the MBIs. The typical format involves individualized training of the parents as in the SoF program, and group parent training with or without parallel group training for their children. These training formats have been helpful in enabling researchers to target specific participants needed for the research studies. But can the group training formats be sustained in clinical practice where individual families seek assistance with family aggression? What has been missing are formats that provide individualized training of the entire family because the family system needs to be the unit of care. After all, aggression is often evidenced in all family members in one form or another and not just in the child with externalizing behaviors. The issue is that groups of families may prove to be rather cumbersome to train not only because of the size of the groups needed, but also because the specific needs of individual families may not be able to be met in large groups. Furthermore, there remains the question of assessment. Most mindful parenting research has relied on the use of rating scales to measure functioning of the parents and their children at pretest, post-test, and follow-up. While this method taps into the face value of specific dependent variables, such as levels of mindfulness, family functioning, and child behavior, it does not provide actual performance data. That is, rating scales provide data on what families and children say they would do, but is it really what they do in practice? Or put another way, the issue is the congruence between attitude and behavior. This is an old behavioral “say-do” correspondence problem much studied in applied behavior analysis (see Lloyd, 1994) resurfacing in current mindfulness research. Self-ratings of how mindful parents say they would be in a hypothetical situation cannot be generally considered strong evidence of how mindfully they would behave when their child is aggressive in real life. The same would apply to ratings of their children and self-rating by their children. We present a case study from our on-going research that begins the process of finding a solution to this problem.

4 Case Study A family was referred for mindfulness training because of the addition of a new member who disrupted a reasonably well-functioning family unit. The family, which included the parents and a daughter, fostered and then adopted a 9-year-old boy who had been in the social welfare system for 5 years following a court decision that his drug-addicted parents were incapable of providing adequate care. Referral information showed that the father was 36 years old and an accountant by profession, the mother was 34 and an elementary school teacher, and the daughter was 11 and a middle school student. The boy had experienced three foster care placements

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that proved to be detrimental to his mental health, leading to explosive outbursts, verbal and physical aggression, and attempting to run away from the third foster home placement. He was placed with the referred family for 6 months as a foster child before they decided to adopt him being fully aware of his mental and behavioral status. Prior to the current referral, they had received family counseling to help integrate the boy within the family unit. A comprehensive psychosocial assessment was undertaken to better understand the family dynamics as well as the characteristics and interactions within the family unit prior to and following the adoption. For this case study, we named the daughter Vida and the boy Peter. In brief, the family unit was very cohesive, loving, and well-­ functioning before Peter was fostered and later adopted. Peter fit in reasonably well within the family system, but his occasional outburst had continued, he was moody at times, and he engaged in verbal and physical aggression with all family members. Functional assessment indicated mixed motivations for his aggressive behavior, including attention, tangibles, and mainly nonsocial. Interviews indicated that Peter’s emotional dysfunction may have been the root cause of his behaviors, including the strong feelings that he was abandoned by his extended biological family, lack of attachment relationships, being bullied in foster care placements, and equivocal trust that his adoptive family is truly loving and accepting of him. It appeared that his explosive outbursts occurred when current interactions were misinterpreted as being reminiscent of past negative experiences in foster care placements. Also, past experiences produced a lack of trust that current positive interactions and assurances that he was a loved member of the family would not end in the same way as before. The family was offered an opportunity to choose the type of intervention they wished to receive—a mindfulness trainer working directly with Peter, or a family member or members trained to teach an MBI to Peter. They requested to learn an MBI as a family unit without singling out Peter as the recipient of additional services because they perceived the situation as a family issue rather than Peter learning to adjust to the family. We initially considered using an existing MBI for this purpose, but the exigencies of the family dictated a simpler and shorter MBI that made limited demands on their time and was conducive to being used by the children and adults alike. Thus, we devised a new MBI that could be used within a family system to change family interactions.

Intervention We based the new MBI on basic principles: mindfulness meditation (i.e., FA and OM), a pause to terminate automatic responding, discernment of response thoughts, and socially acceptable responses. For ease of use, we termed this intervention as Mindfulness-Based Pause, Discernment, and Response (MBPDR). The MB component is the foundational mindfulness-based meditation practice, the P component is the key teaching on patience by Shantideva (2002), the D is discernment of whether

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arising thoughts of specific responses are wholesome or unwholesome, and the R is the choice of a socially acceptable response.

Measures We included two subjective measures (for angst, anger) and two behavioral measures (for verbal aggression, physical aggression). Angst was broadly defined as nonspecific anxiety with associated frustration and negativity. Angst was used as a proxy measure of dukkha which in Buddhism is often translated as suffering, disease, or unsatisfactoriness of one’s present condition. It was rated on a 10-point Likert-type scale with 1 = satisfactory and 10 = totally unsatisfactory. Anger was defined as a strong emotional reaction to interactions with one or more family members. It was also rated on a 10-point scale, with 1 = no anger and 10 = passive non-­ verbal aggression. Verbal aggression was defined as yelling, screaming, cursing, insulting, or any other verbal expression of anger meant to cause mental harm. Physical aggression was defined as hitting, kicking, punching, pushing, and throwing objects. Both verbal and physical aggression events were counted in real time and recorded by each family member who was present. Data were collected during a 10-week baseline phase and then during implementation for the next 40 weeks.

Training Training was provided to the whole family on a weekend day, lasting 6 hours. The family received training in the FA and OM meditations, which they periodically repeated throughout the day’s training. They recorded the guided meditation instructions provided by the mindfulness instructor during the training and then each member used it for personal meditation practice. Training was successively provided on the significance of stopping automatic reaction to angst, anger, and verbal and physical aggression. This was followed by instructions on discernment, which are mental factors defined here as the wisdom to know the difference between wholesome and unwholesome responses. Unwholesome responses are mentally unhealthy and produce negative results, such as disease and unsatisfactoriness with the current situation. This teaching was then linked to discerning the quality of the automatic thoughts that arise when one feels angst and anger or is subjected to verbal and physical aggression. The emphasis was on thoughts being transitory and subject to rising, decaying, and passing by simply observing and letting them go. Further, if one engages in discursive thoughts, the teaching was not only that you are not your thoughts but also not to believe everything you think. Finally, the emphasis in the training was to respond mindfully to all situations with wholesome actions. Detailed instructions and discussion of each of these teachings were provided. Each family member was encouraged to develop a personal meditation practice for about 20 min

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daily. Finally, the family was required to practice together each weekend for 4 weeks, and as needed thereafter. The mindfulness meditation trainer was available for consultation during this period.

Results Each family member was able to adhere to the daily meditation practice, with the mother, father, Vida, and Peter meditating on average about 25, 19, 20, and 15 min, respectively, during the study. Average self-ratings per week for angst and anger on a 10-point scale, with 10 indicating most negative ratings, are shown in Fig. 15.2. Baseline ratings were highest for angst, indicating a general disease with family interactions centered around Peter’s negativity. This decreased substantially across all family members following training in MBPDR. Anger was similarly rated by all family members but at lower levels. No family member rated the occurrence of either of these feelings during the last 16  weeks of the 40-week intervention. Observational records by family members for verbal and physical aggression are shown in Fig. 15.3. During baseline, Peter had the largest average number of verbal aggressions when compared to those of the other three family members. These were reduced to very low levels following family training in MBPDR. Except for Peter, no other family member engaged in physical aggression during baseline. Peter engaged in physical aggression on average about six times per week during baseline, but only one per week following intervention. No family member, including

Fig. 15.2  Family ratings for angst and anger during baseline and MBPDR intervention

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Fig. 15.3  Family ratings for verbal aggression and physical aggression during baseline and MBPDR intervention Table 15.1  Descriptive statistics, TAU-U coefficients, Z-scores, and p-values for aggressive behavior of the family members during the baseline and the MBPDR training Participants Aggressive behavior Baseline mean per week Baseline range MBPDR training mean per week Intervention range TAU-U Z-score p-value

Mother Verbal 2.10 1–4 0.10 0–1 −0.97 −4.71