Spousal Partner Abuse (Page 2)


    Health Needs of Human Trafficking Victims

    July 2009

    Erin Williamson, Nicole M. Dutch, and Heather J. Clawson
    Caliber, an ICF International Company


    On September 22 - 23, 2008, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) within the U.S. Department of Health and Human Services (HHS) sponsored a national symposium focused on the health needs of human trafficking victims. This symposium developed from an exploratory study, funded by ASPE, examining how HHS programs are addressing the needs of victims of human trafficking. This symposium brought together health care workers and members of the anti-human trafficking community to discuss trafficking victims’ health needs, how best to identify victims in health care settings, and ways that the health care system can provide improved and effective health care services to this population.

    More than 150 experts and professionals from a variety of fields attended the symposium. Attendees included directors of national medical  associations; program directors of hospitals located in communities highly affected by human trafficking; medical personnel working in clinics and organizations serving victims of human trafficking; executive directors of anti-trafficking organizations; and government officials from HHS, U.S. Department of Justice, U.S. Department of Labor, U.S. Department of State, U.S. Department of Education, U.S. Agency for International Development, and U.S. Congress.

    The symposium was organized in five major panel sessions, each of which ended with a discussion among attendees and panelists. Session 1, Introduction to Trafficking as a Health Issue, provided an overview of the issue including the role of various government agencies working to combat human trafficking, major cases prosecuted by the Department of Justice, certification of international victims by the Office of Refugee Resettlement within HHS, and the major health consequences of human trafficking. Session 2, Encountering Victims: Identification, Disclosure, and Other Issues, took a closer look at victims of human trafficking, challenges in identifying victims, key indicators to improve identification, how victims present themselves to health care settings, and how the Health Insurance Portability and Accountability Act might affect services to this population.  Sessions 3 and 4 focused on Health Service Provision to Victims, examined the physical, emotional, and mental health issues affecting this population, public health concerns resulting from human trafficking, medical services currently available, and additional resources needed to improve service delivery. In Session 5, Lessons Learned and Promising Practices, agencies successfully treating the physical and mental health needs of human trafficking victims described their programs and promising practices.

    This brief presents an overview of the major topic areas discussed during the National Symposium on the Health Needs of Human Trafficking Victims. The brief focuses primarily on the post-session discussions and suggestions to improve the delivery of health services to victims.

    Understanding the Definition of Human Trafficking
    and its Relationship to Other Populations

    The Trafficking Victims Protection Act of 2000 (TVPA) defines trafficking as the use of force, fraud, or coercion to compel labor and/or commercial sexual activity. Under this definition, human trafficking can present itself in multiple ways and numerous settings. While the TVPA legally defines human trafficking, symposium participants and anti-trafficking experts pointed out that this comprehensive definition is not often used in the public arena, and sometimes it is not even employed by anti-trafficking service providers and advocates, who might view human trafficking as confined to foreign-born women subjected to sex trafficking. These discussants cited the media and other public outlets as common sources providing a restricted view of human trafficking that applies only to female victims of sex trafficking. This narrow focus disregards the significant number of male and transgender victims, as well as the millions of victims of labor trafficking who may not have experienced sexual coercion as well. It also does not adequately recognize those U.S. citizens or legal permanent residents subjected to sex or labor trafficking who never cross any national boundaries (i.e., domestic victims). The relevant criteria establishing whether an individual is a trafficking victim is the presence of force, fraud, or coercion, not movement across geographical space or membership in any nationality group.

    In addition, anti-trafficking representatives pointed out that victims are sometimes defined narrowly as coming from the same background or sub-population. For example, reports on child sexual exploitation often assert that a significant number of minor, domestic female victims of commercial sexual exploitation are runaways. While this may be true for some domestic victims, assuming this is the case for all such female minor victims of sex trafficking may result in practitioners maintaining false assumptions and/or obtaining incomplete and inaccurate histories; this can result in unanticipated and potentially hazardous treatment strategies and outcomes. For example, if a physician working with a juvenile patient assumes he or she is a runaway, the physician may infer that something at the patient’s home prompted him or her to run away. This assumption could hinder family reunification for victims who are not runaways, or for whom reunification may be preferable. Symposium attendees representing multiple constituencies emphasized the importance of understanding that victims of trafficking can come from a variety of backgrounds and experiences and exhibit a wide range of characteristics.

    Symposium attendees concluded that discussions on human trafficking must take place at the practitioner and policy levels and incorporate a comprehensive definition of human trafficking in order to address the health issues facing this population and ensure proper care for all victims.

    However, within this broad definition are several discrete categories of victims who often may need different types of services and support.

    Sub-Populations of Human Trafficking that Require Specialized Attention

    Domestic victims of human trafficking were a sub-population discussed frequently throughout the symposium. While the majority of human trafficking victims in the United States are U.S. citizens, law enforcement, medical practitioners, and social service providers all pointed out that the resources for domestic victims are not comparable to those available for international victims. They observed that shelter is one of the most inadequate resources for domestic victims. While advocates for victims of domestic violence have effectively demonstrated the need for and benefits of shelters, social service practitioners note these shelters typically do not have the necessary personnel or resources to support victims of human trafficking, especially victims of labor trafficking. In some cases, female victims of trafficking refer to pimps as boyfriends, thus confusing whether cases involve domestic violence or trafficking. Additionally, shelters tend to be for females and, therefore, unavailable for male and transgender victims of human trafficking. Law enforcement and community organizations report having a difficult time locating adequate short- and long-term housing for domestic victims who escape their trafficking situations. As a result, many domestic minor victims are housed in juvenile detention centers, which often do not recognize or treat these youth as victims of a crime, but rather as perpetrators. A number of attendees identified the need for additional resources to establish specialized short- and long-term housing options for domestic victims, particularly minors.

    Social service providers also noted that accessing public benefits can be difficult for domestic victims of human trafficking. They report that while programs such as food stamps and Temporary Assistance for Needy Families (TANF) exist, they have eligibility requirements that may limit participation by domestic victims. For example, the Food Stamp program (now called the Supplemental Nutrition Assistance Program, or SNAP) generally requires applicants to have proof of address, a birth certificate, and a Social Security card, which most domestic victims do not have at the time they escape their trafficking situations. While victims can apply for various forms of identification, this process can be cumbersome and time-consuming, leaving victims at high risk for re-victimization and hindering attempts to receive public assistance. Additionally, prior arrests for solicitation or other offenses often result in ineligibility for food stamps and other programs. TANF requires individuals to be at least 18 years of age and have at least one child. As a result, social service providers report that minors with children and adults without children are generally ineligible for this program.

    Adults and children with special needs are also likely to require particular attention and services. Social service providers and researchers report that individuals with special needs are disproportionately targeted by traffickers. They added that these victims may be more vulnerable due to mental impairments as well as their need for financial resources to pay for medical care. Very little is known about how best to treat and work with this sub-population in the short-term as well as what resources are needed for their long-term care.

    Victims of labor trafficking may also require special attention. For example, they may suffer permanent and/or chronic medical conditions requiring intensive and lifelong treatment. For children, these medical conditions can severely affect their physical development. One example of this is children exposed to chemicals harming their respiratory system and hindering proper lung development. In addition, victims of labor trafficking may also have experienced sexual assault during their trafficking experience, putting them at risk for an increased number of associated health and mental heath issues. Since little research exists regarding labor trafficking, including the number of victims and their needs, as well as the health consequences of labor trafficking in the United States, more work is needed to ensure the health care needs of this sub-population are properly identified and met.

    Attendees also pointed out that children of adult victims require specialized attention, especially children who are at heightened risk for trafficking as a result of their mothers being in prostitution. Social service providers report that more resources are needed to effectively identify and prevent these children from becoming victims themselves. Gay, lesbian, and transgender youth are also at elevated risk for trafficking according to victim service providers. When these children escape their trafficking situations, they often need specialized support and services to help them overcome significant identity issues that can result from their trafficking experiences. For example, social service providers report that domestic, female victims of trafficking often initially identify themselves as being lesbian then later identify as straight or bi-sexual. There is little known regarding the cause of this phenomenon or whether these identity issues existed prior to their trafficking experience; however, providers note that this issue of identity is one that many domestic female victims struggle with as part of their recovery. Children and adults can also experience re-victimization if their images have been posted online. Medical professionals serving victims of human trafficking cited online images as a major factor in computer aversion, which can significantly affect completing school or attaining gainful employment. Additionally, representatives of anti-trafficking organizations report that more attention is required for children who are trafficked into the United States for the purposes of adoption, as well as U.S. children trafficked abroad.

    Physical and Mental Health Professionals’ Roles in Prevention

    Mental health providers and researchers emphasize the importance of medical providers having a holistic understanding of human trafficking as well as an appreciation for sub-populations requiring specialized attention. They point out the unique role health care providers can fulfill in terms of screening for individuals at risk for human trafficking. Social service providers affirm that individuals can be at risk for human trafficking as a result of a history of abuse, runaway tendencies, and low income or poverty, in addition to a variety of other factors. They acknowledge that physical and mental health providers are often privy to information crucial to effective prevention. For example, doctors or nurses who are aware of a minor’s history of physical, emotional, or sexual abuse can incorporate screening questions into their sessions to identify indicators of potential trafficking at early stages. School nurses aware of families needing additional financial resources could alert youth in those families to labor trafficking and ways to identify safe employment options. Mental health providers also suggested examining those sub-populations who are at risk for trafficking yet were not victimized to better understand what factors might be critical to preventing human trafficking.

    Factors Contributing to Identifying Victims and Providing Services

    Social service providers and medical professionals confirm a number of contributing factors can complicate identifying victims of trafficking and providing services to them. A common reason victims of human trafficking are not identified, and therefore do not receive proper care, is because these cases are misclassified. For example, many cases of sex trafficking, especially those in which victims are romantically involved with their traffickers, are identified as sexual or domestic violence cases. Cases of human trafficking are sometimes even processed as domestic violence cases in the court system. Social service providers anecdotally report this is partly due to limited awareness among law enforcement personnel, community service providers, and medical professionals about the scope of the definition of human trafficking. They assert first responders should be adequately trained about this issue so they can properly identify and respond to victims they encounter, including domestic victims.

    Symposium attendees described additional barriers to identifying and providing services to international victims of human trafficking. They reported that one of the largest barriers for this population is language. International victims often have limited or no understanding of English. Victims of labor and/or sex trafficking may have signed illegal contracts that they believe legitimize their circumstances. International victims seeking medical and social services usually require the assistance of a translator. Service providers indicate that in order to ensure international victims are properly identified and safe, independent, confidential translators must be available. However, medical and social service providers acknowledge this requirement can be extremely challenging, if not impossible, to meet. Even providers in New York City, which has many multi-lingual communities, noted difficulties in finding appropriate translators when non-English speaking clients present themselves. Additionally, language phone lines can be costly and uncomfortable for both clients and providers, and may not be able to provide translation for all  client languages.

    Lack of cultural competency by health care providers can also significantly hinder the effectiveness of medical care provided to international victims. Social service providers at the symposium emphasized that an important part of cultural competency is the understanding and use of alternative medicines. They report that international as well as some domestic victims of human trafficking often come from cultures in which folk healing, healing rituals, and secret societies are commonly accepted and used. For example, some African-based therapeutic systems subscribe to the idea that only practitioners belonging to secret societies are able to provide proper psychological treatment. Social service providers also note that cultural competency entails understanding the cultural and religious beliefs surrounding certain medical practices and procedures, such as consuming prescription drugs, using birth control, and undergoing abortions. Successfully working with and treating these clients calls for incorporating into treatment the medical techniques with which victims are familiar and comfortable. Social service providers describe this as being especially true for children who need a comfortable and supportive environment. They suggest that medical practitioners be able to make referrals to specialized providers if they are not familiar or comfortable with medical treatments used by certain populations.

    Illiteracy, and specifically health illiteracy, often hinders victim identification and proper medical care. Organizations working with victims of human trafficking point out that many victims, both international and domestic, are illiterate. Therefore, they may be unable to read pamphlets, posters, or other written materials providing important medical information. Additionally, as our culture becomes more dependent on technology to communicate, increasing amounts of information about social services and medical care are being disseminated through the Internet. Individuals who are illiterate, have limited or no understanding of the English language, and/or have no access to the Internet have increasingly less access to crucial information.

    The consequences of human trafficking on mental health cannot be overstated. Victims of human trafficking have experienced considerable trauma, some of which does not present itself until years later. According to mental health service providers working with this population, practitioners need to have specialized training to most effectively provide care to clients experiencing trauma. One of the unique aspects of human trafficking that can lead to significant trauma is the fact that these victims have been paid for the harm perpetrated against them. Monetary payment for forced labor and/or sexual services and the social normalization of prostitution often result in victims receiving conflicting and confusing messages regarding their experiences. Treating only physical symptoms without addressing the underlying trauma will not effectively help this population overcome their experiences. Attendees acknowledged that in order to address short- and long-term trauma, adequate health care coverage that includes mental health services is imperative for all victims.

    Practitioners from a variety of fields indicated that coordinated service delivery is essential to preventing re-victimization. Victims often experience significant co-morbidity of physical and mental health problems, which cannot be treated as if they exist separately. Health providers and social service agencies recognize the need to develop relationships and systems to better coordinate service delivery, especially for helping victims move from emergency services to long-term rehabilitation and stability. Communities that have successfully developed integrated service delivery systems should be studied and their best practices should be shared.

    Working with victims of human trafficking can be extremely draining on service providers. Mental health providers reported that compassion fatigue and vicarious trauma among service providers can dramatically affect services. Organizations and individual practitioners working with this population need to ensure they have the supports necessary to sustain their work on behalf of victims.

    Re-traumatizing victims within ostensibly “safe” institutions is a serious concern. For example, providers working with victims in juvenile detention centers and other public systems pointed out that victims may be re-traumatized within those systems.

    Similarly, social service providers reported that some international victims have been re-traumatized by systems that treated them as suspected terrorists. Mental health workers testified that the majority of victims within such public institutions have not had their trafficking experiences recognized as traumatic. They suggested training and education could help these systems learn how to work with victim populations in a way that is not re-traumatizing.

    Mental health providers noted the role of resilience, not only in preventing human trafficking but also in helping victims of trafficking deal with and overcome their trafficking experiences. They cited dissociative disorders and other mental health conditions as coping mechanisms victims adopt to survive their trauma. While the importance of resilience in helping victims of human trafficking is anecdotally recognized, the variation in the treatment outcomes of victims indicates the need for further research to better understand its role in victims’ ability to overcome traumatic experiences.

    Human Trafficking as a Public Health Issue

    The symposium not only focused on the health care needs of individual victims of trafficking but also the public health consequences of human trafficking. The majority of research on human trafficking as a public health issue has focused on its effect on the prevalence of tuberculosis, HIV/AIDS, and Hepatitis B. Social service providers working with victims near the United States-Mexico border recognize the significant threat of cross-border contamination among the populations they serve. Government officials reported working on cross-cultural collaborations to examine and reduce cross-border contamination. But both government representatives and social and health service providers agreed that more work is needed in this area.

    Training Physical and Mental Health Professionals

    One of the major outcomes of the symposium was the recognition that training the medical field on the issue of human trafficking is imperative to improve identification of, and service delivery to, victims. Health care and social service providers also acknowledged that simply training first-responder medical personnel, such as emergency room physicians or emergency medical technicians, is not sufficient; all medical professionals, including those working in other public systems such as the justice system, need proper training. Participants also agreed that special efforts should be made to ensure medical professionals serving marginalized populations, such as nurses and physician assistants working with needle exchange programs, also receive training about human trafficking. Training would assist with identifying and treating victims and enhance prevention so health professionals could identify clientele at risk for trafficking.

    An improved training strategy would integrate the issue of human trafficking into the general and continued education of medical professionals. A number of medical professionals suggested that various medical associations, such as the American Medical Association, American College of Obstetricians and Gynecologists, and American Academy of Pediatrics, should focus their attention and resources on the issue of human trafficking. Social service providers and medical professionals suggested incorporating human trafficking into continuing education courses with a focus on quality of care, safety issues, and potential malpractice. Others suggested incorporating the topic of human trafficking into the larger issue of patient experience with violence and abuse.

    Social service agencies have had some success in working with associations. However, they understand medical associations took significant time to recognize domestic violence as an issue, and are committed to continuing work with associations to gain attention for human trafficking.

    Social service providers and medical professionals also discussed adding human trafficking to the standard educational curricula of doctors, nurses, social workers, psychologists, and other health professionals. They suggested creating a comprehensive human trafficking curriculum that could be adapted and used by a variety of institutions and audiences. The curriculum could be augmented by more specialized, targeted curricula, for example curricula specifically for emergency room nurses. Attendees identified a variety of existing training tools for the medical field, but believed developing a standard human trafficking curriculum would be valuable.

    Attendees discussed who would be best equipped to provide training on human trafficking to the medical field. Medical professionals and social service providers agreed the training should be conducted by a peer (e.g., a nurse would train other nurses). However, they also acknowledged that the demand for training of medical professionals is much greater than the number of qualified medical professional trainers. Social service agencies offered examples of how they have successfully trained medical professionals. They noted that social service providers can sometimes present a more comprehensive perspective on the array of issues trafficking victims face. Social service providers also suggested having victims participate in training, enabling health care professionals to learn first-hand about their experiences.

    Educating the Public

    In addition to educating health care professionals, symposium attendees discussed the importance of educating the broader public, including individuals in other professions who may encounter this population. Human trafficking has received greater media and public attention; however, attendees noted that the majority of people in the country remain unaware of this problem, especially as it relates to labor trafficking and domestic victims. Social service professionals reported coming into contact with people from all walks of life who may have witnessed instances of human trafficking but lacked the proper information or resources to recognize it. They expressed the need for further and ongoing public education and awareness building to successfully address human trafficking.

    Research and Data

    Ongoing research and comprehensive data regarding the health care needs of, and services available to, victims of human trafficking can help ensure services meet their health and mental health needs. Medical professionals, social service providers, and researchers in the anti-trafficking movement expressed concern that no data tracking systems exist to accurately evaluate current health service delivery systems for victims of human trafficking. They noted this deficiency at both the local and national levels. Social service providers agreed lack of data not only hindered assessment of services they provide, but also impeded funding to enhance services as government and non-government funders request data to demonstrate victims’ needs for services and agency needs for financial support. Yet they cannot obtain data without funding to build data infrastructure and conduct research. One health care provider working with this population suggested instituting a public health task force to assist with data collection for victims’ services.

    Social service providers and researchers affiliated with universities reported working jointly on research projects to assess health needs and services for victims of human trafficking, but they agreed that an overall infrastructure for data collection is lacking in the anti-trafficking field. All attendees acknowledged that data collection is an enormous challenge given service providers’ limited time availability and lack of expertise in developing and implementing data collection systems.

    In addition to data collection and evaluation of services, symposium attendees identified other areas in which further research is needed:

    • Demand reduction programs
    • Societal factors promoting solicitation of commercial sex
    • Typologies of traffickers
    • Typologies of the consumer or end user (e.g., “johns,” employers)
    • Economic factors involved in trafficking
    • Health consequences of labor trafficking in the United States
    • Financial impact of human trafficking in terms of health and mental health services
    • Public health impact of human trafficking in the United States
    • Role of resiliency among victims
    • Protective factors for vulnerable populations
    • Best practices for treating victims of human trafficking CEU

    Attendees agreed that human trafficking is more likely to be eliminated or reduced if the motives of traffickers and other exploiters (e.g., johns, employers, relatives) can be understood and their activities prevented. They also cited the importance of integrating public awareness and corporate responsibility into preventing labor trafficking. Representatives of anti-trafficking organizations and service providers working with trafficking victims commented that they were not fully aware of best practices being implemented by other anti-trafficking organizations and recommended an improved infrastructure for sharing information. They suggested starting with a listserv that included symposium attendees to begin building a community of practice for information sharing.

    Human Trafficking and Related Fields

    While human trafficking has an extensive history, the Federal government only recently enacted the TVPA, which established new programs and services for victims of human trafficking. Accordingly, symposium attendees recognized that the anti-trafficking field can learn significant lessons by examining best practices and advances in similar fields, including domestic violence, child sexual abuse, victims of torture, and refugees. Medical providers observed that several best-practice models have been created and implemented in the United States and a number of suggestions presented at the symposium have been successful in other fields.

    Social service providers and government representatives also encouraged building coalitions and partnerships between those in the anti-trafficking field and individuals and organizations in related fields in order to share information, ideas, and resources. Anti-trafficking service providers believed services currently are provided within distinct categories in which an individual is treated as a refugee, victim of torture, or victim of human trafficking, as opposed to an approach that is based on a more inclusive, multi-dimensional framework. Attendees felt an integrated, multi-dimensional approach was especially important for law enforcement and prosecutors whose mandates tended to encourage them to investigate and prosecute cases within strictly defined guidelines and parameters. Coalitions and stronger partnerships would assist in creating a multi-dimensional, victim-centered framework of service provision and would help reduce duplication of services. Anti-trafficking representatives from Florida noted they have begun implementing a multi-dimensional framework in their trainings, which has helped service providers from various backgrounds compare and contrast human trafficking needs and services across related fields.

    Symposium participants recommended greater collaboration among service providers and agencies in various fields and encouraged improved and increased data collection among government agencies addressing human trafficking.


    The National Symposium on the Health Needs of Human Trafficking Victims provided a unique opportunity for members of the anti-trafficking community and health care professionals to begin discussing ways to improve identifying and providing services to human trafficking victims in medical settings. Participants identified specific ideas, contacts, and next steps that could build on the relationships established and lessons learned at the symposium. As with efforts to provide effective services to victims of crime, violence, and abuse, participants recognized both the progress that has been made and the steps that still need to be taken.

    Addressing the Needs of Victims of Human Trafficking:
    Challenges, Barriers, and Promising Practices

    August 2008

    Heather J. Clawson and Nicole Dutch

    I. Study Overview

    This is the fifth in a series of Issue Briefs produced under a contract with the U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Planning and Evaluation (ASPE), to conduct a study of HHS programs serving human trafficking victims. Funded in the fall of 2006, the purpose of this exploratory project is to develop information on how HHS programs are currently addressing the needs of victims of human trafficking, including domestic victims, with a priority focus on domestic youth. This project also reviewed relevant literature, and identified barriers and promising practices for addressing the needs of victims of human trafficking, with a goal of informing current and future program design and improving services to this extremely vulnerable population.

    This issue brief focuses on the needs of victims of human trafficking and the services available to meet those needs. Additionally, it discusses challenges and barriers to providing services to victims, international and domestic, adults and minors, and highlights innovative solutions to these challenges and promising practices to overcome barriers. Throughout the brief we make distinctions, where appropriate, between international adult victims, international minor victims, and domestic minor victims. No information was available regarding domestic adult victims as agencies did not report providing services to this population. There also is no current research or literature providing information on serving this population.

    II. Understanding the Needs of Victims of Human Trafficking

    Common Needs

    When service providers and law enforcement personnel were asked to describe the needs of victims of human trafficking, a common response was, “what don’t they need.” The table on the next page shows the responses given by those service providers participating in the study.(1) The safety needs of victims were identified as the first priority by all of those working with victims. According to law enforcement and providers, screening for safety needs (for both the victims and providers) is part of every assessment they conduct. Safety needs are often met when the next priority need for (safe) emergency housing is addressed. Other emergency needs include food and clothing and, for international victims, translation services to avoid feelings of isolation and to facilitate communication regarding other needs.

    Once emergency needs are met, other needs that present themselves in the short- and long-term need to be met. These include housing (transitional and permanent for adults, and foster care or permanent placement for minors), legal assistance (e.g., help in understanding legal rights, legal representation and, for international victims, assistance with filing T-visa applications, and immigration petitions), and advocacy (e.g., assistance retrieving identification documents, completing applications, attending appointments, and navigating the different U.S. systems, including criminal justice, child welfare, immigration, human services, transportation, etc.).

    Additionally, service providers and law enforcement note that most victims also need health screening (tuberculosis, sexually transmitted diseases, pregnancy), vaccinations/immunizations, medical treatment for physical injuries, and dental care. Other service needs include child care (for both adults and minors with children), education (GED assistance, enrollment in school, technical training/certification), life skills training (including assisting some international victims with operation of basic household appliances, using public transportation, using a telephone, mailing a letter, etc.), job training, finding employment, financial management, and where appropriate, family reunification or repatriation.

    In addition to the above service needs, service providers report that all victims of trafficking have some type of mental health need.Specifically, service providers indicated that as a result of the trauma experienced, victims need trauma counseling and for domestic minor victims in particular, they often need anger management, conflict resolution, and family counseling.

    � � � � � � � � � � � � � � � � � � � � � � � � � �

    Needs of Victims of Human Trafficking



    Domestic Minors




















    Legal Guardianship





    Transitional housing




    Long-term housing




    Permanency placement




    Legal assistance












    Medical care




    Mental health/counseling




    Substance abuse treatment








    Life skills








    Financial assistance/management




    Job training/employment




    Child care








    * While substance abuse treatment may be a need for international victims,
    it was only identified as a need for domestic minor victims

    Differences in Needs

    While the needs are relatively similar regardless of whether someone is an international or domestic victim, adult or minor, one point is clear-the magnitude of these needs varies for each victim depending on his or her circumstances.

    For example, international victims often express a greater and more urgent need to obtain employment than domestic victims do. This is reportedly the result of their desire to send money back home to support their families.

    Additionally, while obtaining identification documents (e.g., passports, birth certificates, driver’s licenses) is reported to be an important need for all victims in order to access services, it is especially important for international victims to have some form of identification or legal documentation on hand. One service provider told of an incident where a client was removed from public transportation and placed in detention because the client did not have any identification on his/her person and had not yet received his/her certification letter indicating he/she was a victim of human trafficking. This experience exacerbated the client’s situation and need for ongoing legal assistance.

    Legal assistance is one other area where there are differences in degree or type of need between international and domestic victims. While both have legal needs, international victims, often in the U.S. illegally, have more complex legal needs usually related to their immigration status. This includes needing representation at deportation hearings, assistance with applications for T visas and derivative visas, and renewal applications.

    While it is not necessarily unique to domestic victims, service providers report that domestic victims often present with serious substance abuse issues. Some providers report that while international victims also need assistance with similar problems, they are less likely to admit they have a problem out of shame, fear of stigma, or denial that their substance abuse constitutes a problem. In some cases, the service providers do not want to indicate this as a need of international victims for fear access to treatment records will be subpoenaed and used against the victim in a legal case (criminal, civil, or immigration).

    Regardless of the victim, law enforcement and service providers stress that it is not so much the type of needs that vary by victim, but the duration of services required to address those needs and the level of difficulty obtaining such services.

    III. Services Available for Victims of Human Trafficking

    Prior to the passage of the Trafficking Victims Protection Act of 2000 (TVPA), law enforcement and service providers report struggling to piece together the comprehensive services needed by international victims of human trafficking with scarce resources. Under the TVPA, HHS was designated as the agency responsible for helping these victims of human trafficking become eligible for benefits and services and funds were allocated for the delivery of such benefits and services. One responsibility of HHS is to certify adult international victims of trafficking who are not U.S. citizens or legal permanent residents (LPRs) once they are identified. This certification allows adult international victims to receive the same benefits and services available to refugees. U. S. citizens or LPRs who find themselves victims of trafficking (i.e., domestic victims) do not need to be certified in order to receive benefits. In the case of citizens, they are already eligible for many benefits and services they might need. And although LPRs face greater benefit restrictions than U.S. citizens, they do not face the same eligibility restrictions as undocumented immigrants, which is usually the status of international adult victims when they are first identified. International minor victims of trafficking (under the age of 18) do not need to be certified but instead receive a letter of eligibility from HHS and are then eligible to apply for a similar range of services as refuges, including the Unaccompanied Refugee Minor (URM) Program.

    The Unaccompanied Refugee Minor (URM) Program
    for International Minor Victims

    International minors who are determined to be victims of human trafficking by law enforcement officials are eligible for the T visa, which allows victims of trafficking to remain in the U.S. and become eligible for work authorization. Additionally, international minor victims without a parent or legal guardian in the U.S. are eligible for services under the Unaccompanied Refugee Minors (URM) program. The URM serves as a legal authority designated to act in place of the child’s unavailable parents. Children are placed in foster homes, group homes, or independent living arrangements. Through the URM, children can receive intensive case management, education, health care, mental health counseling, independent living skills training, assistance with family reunification and repatriation, and other services until they turn 18 or such higher age, depending on the foster care rules of each state.

    In order for an international adult victim of trafficking to receive certification he or she must first be determined to be a victim of a severe form of trafficking as defined by the TVPA and he or she must be willing to comply with all reasonable requests to assist law enforcement in the investigation of the trafficking case (minor victims are exempt from this requirement). Following this determination, the victim must complete a bona fide application for a T visa, receive a T visa, or be granted “continued presence” by federal law enforcement. T visas were established under the TVPA and allow victims of trafficking to become legal temporary residents of the United States. Once a T visa is obtained, a victim may remain in the U.S. for up to three years. At the end of this time period the victim may be eligible for legal permanent residence status.

    Certified adult victims are eligible to receive federally funded services and benefits similar to refugees. Some of the services that victims of trafficking are eligible for through federally funded programs, such as the Per-Capita Victim Services Contract include housing or shelter assistance, food assistance, income assistance, employment assistance, English language training, health care assistance, and mental health services.

    Per-Capita Victim Services Contract

    The Per-Capita Victim Services contract is designed to centralize services while maintaining a high level of care for victims of human trafficking through “anytime, anywhere” case management. Working in concert with HHS’ ongoing Rescue & Restore public awareness campaign, subcontractors are reimbursed for the services actually provided to each human trafficking victim. The contract also streamlines support services in order to help victims gain timely access to shelter, job training, and health care.

    For more information, please contact mrs@usccb.org

    Prior to becoming certified, a period referred to as pre-certification, victims pursuing certification and cooperating with law enforcement can receive limited, often emergency services, which parallel most certification services as a result of funding available from HHS and other federal agencies. Pre-certification services include housing, food/clothing, advocacy, legal assistance, medical/dental care, language services (e.g., interpreters/translators), mental health counseling, education, and job training.

    In addition, service providers report seeking other assistance for victims who may decide not to cooperate with law enforcement out of fear of retaliation from the traffickers, or for other reasons. The strategies to assist these victims may include seeking asylum for the victim or filing for a U-Visaand accessing services under the Violence Against Women Act, or for some agencies, tapping into non-federal or unrestricted funding streams to provide ad hoc services (for example, from state or local government programs, foundation-funded programs, etc.).

    IV. Challenges and Barriers to Meeting the Needs of Victims

    While there seems to be consistency between the needs of trafficking victims and the services for which they are eligible and the programs in place to provide these services, there are many challenges and barriers to getting victims into service.

    Lack of Knowledge and Understanding. One of the most common and frustrating challenges reported by law enforcement and service providers is the lack of knowledge and understanding regarding human trafficking among service providers, law enforcement, and even victims themselves who often do not believe or understand that they are a victim of crime. As a result, victims often go unidentified and unserved.

    Lack of knowledge and understanding of what services are available is a barrier for service providers as well. Many service providers report their own confusion regarding what services their clients are eligible for and can access, which highlights the need for effective case management as identified in a previous Issue Brief.

    “There is a general lack of knowledge and understanding of human trafficking and not enough service providers in the healthcare profession, local Social Security Administration offices, department of motor vehicles, and other key agencies are trained on this issue and know they can serve these clients. We are constantly having to take our clients to appointments because they are turned away when they try on their own.”

    Service Provider

    Availability of Services. Even though victims, international or domestic, may be eligible for services, the availability of those needed services is often limited due to long wait lists and associated fees (even if offered on a sliding scale). As one provider indicates, “Free clinics are not always free. You spend a lot of time waiting to be seen and there are often some unexpected charges associated with most services.” According to service providers, this is particularly true for mental health services and substance abuse treatment.

    While accessing basic medical services (physicals, gynecological exams, screenings, etc.) is not reported as a problem for most service providers (with the exception of some providers in rural communities), accessing specialized medical treatment was problematic. Specifically, specialized care for acute, long-term needs, such as diabetes, cancer, and other illnesses, including prescriptions that are part of the treatment, were often cost prohibitive and in some cases, exhaust program resources.

    “As a service provider, I find it confusing trying to figure out what services are available for which clients [international or domestic]. Most of my time is spent making calls or running around to agencies. We [service providers] need a road map that helps explain not only what services our clients are eligible for but how we go about accessing these services. What documentation does my client need? What paperwork do they need to fill out? What would make my client ineligible for services? I can barely navigate through all of these systems myself, so how can we expect our clients to take this on?”

    Service Provider

    Similarly, while most service providers are able to find basic dental care for their clients (although sometimes there are long waiting periods), more serious and costly dental procedures, such as root canals and extractions, are difficult to obtain.

    Housing is another service that law enforcement and service providers report is limited. While finding emergency shelter for women and girls is not usually a problem, finding the same placements for men and boys is difficult. Transitional and permanent housing is scarce for everyone but in particular for domestic minors with felony convictions and victims with mental health or substance abuse issues.

    “There just isn’t affordable housing in our community for anyone. We often end up placing groups of victims together in apartments or houses. Sometimes this works but sometimes the only areas where they can afford housing are high crime areas. We’ve actually had clients become the victims of other crimes (burglary) because they could only afford to live in unsafe neighborhoods.”

    Service Provider

    Finally, the availability of services in general for domestic victims is viewed as problematic by some service providers. As one provider states, “If you just look at what domestic victims are eligible for on paper, it looks promising. However, trying to access those services is another story.” Several examples include referrals to child welfare agencies by service providers and law enforcement only to find out that the agencies would not see the domestic victims because the abuse did not occur at the “hands of a parent or legal guardian.” In these cases, providers and law enforcement report minors falling through the cracks of the mainstream system and not receiving services. In some cases, minors were handed back to their abusers and “turned back out on the streets.”

    Appropriateness of Services. Service providers talk not only of the need for more culturally appropriate services, but also for gender appropriate services. Finding such services can be challenging, particularly in rural communities. Additionally, service providers stress the importance of understanding what is meant by culturally appropriate services. For instance, just having someone from the same culture who speaks the same language does not translate into culturally appropriate services according to service providers. Speaking the same language as clients can help facilitate service provision but that is just one piece of one’s culture. Service providers gave examples of victims of sex trafficking who were not comfortable talking about their experiences with someone from their same culture out of the associated shame and stigma. Other examples given by service providers were related to the gender and culture of the victim. For example, in some cultures, it is not appropriate for a female to visit a male doctor. Recognizing these challenges and the implications for providing appropriate services to clients is seen as critical by providers themselves.

    The appropriateness of services also extends to examining the culture of the environment in which the service is offered. For example, service providers note that providing services to victims who are living in shelters can be difficult and some environments can result in “revictimization.” In particular, providers share examples of sex trafficking clients being placed in domestic violence shelters and then facing humiliation and isolation. For international sex trafficking victims, the isolation is usually attributed by service providers to language barriers and cultural differences. But for domestic victims of sex trafficking, the humiliation and isolation, according to service providers and some victims, is attributed to perceptions that domestic victims are “prostitutes,” or willing participants, rather than victims of abuse and crimes. These misperceptions reflect again, a general lack of understanding and knowledge of the issue, not only among service providers but in the general public.

    Access to Services. The two greatest barriers to accessing services for international victims include language barriers and transportation. Service providers indicate that the availability of information and access to providers that speak English, Spanish, and in some communities Korean, is not difficult. It is their clients that speak other languages that have difficulty accessing services.

    Additionally, transportation is a problem. In large cities, teaching clients how to use the transportation system can be overwhelming and very time consuming. Service providers report clients missing appointments because they were afraid to use public transportation. In smaller communities, there is often limited or no public transportation, also making it difficult for clients to get to appointments.

    “There is no cookie-cutter approach to working with this population. Males, females, adults, children, sex trafficking, or labor trafficking. You just don’t know how long you will be working with them. Just when you think they are moving forward, something happens with their case or with their family or they see something in the news that triggers the trauma experience and sets them back sometimes months in their progress. A lot of times it is one step forward and two or three steps back. You just have to be prepared for setbacks.”

    CEUService Provider

    Length of Services. Another challenge identified by service providers and victims themselves is the length or duration of the services available to victims. Service providers note that the timeline to self-sufficiency varies by client. Some clients may come in, get certified right away and be ready to work, especially among many labor trafficking victims. Other victims, however, may remain pre-certified for a longer period of time and even after becoming certified, they may not be ready to work or move forward with their lives. According to service providers, individual timelines are difficult to predict. However, with close monitoring and anticipation of set-backs (e.g., depositions, appearances at trial, intense counseling sessions, reunification, etc.), providers are able to adjust services to meet the changing needs of clients.

    For domestic minors, shelter stays are often limited to 15-, 30- or 90-days and do not allow providers enough time to establish relationships with victims or provide adequate services to meet their longer-term needs. Transitional housing for domestic minors and domestic victims is often limited, and when available victims often find it difficult to follow the rules/restrictions of the facilities (e.g., no drug/alcohol use, required employment).

    “When working with a domestic victim, I just need more time. I can’t stabilize a client with an extensive trauma history within 90 days or transition them to permanent housing within 18-months. Many of my clients struggle to get clean, get an education (or GED), learn life skills, obtain employable skills, and get employed. This is especially true if they have not begun to work on trauma recovery and this can take years.”

    Service Provider


Lack of Coordination of Services. For the most part, service providers acknowledge improved coordination of services for clients over the past several years. However, they see the need for a single point of contact within each agency working with victims and a central case manager to ensure communication and coordination of services.

This appears to be especially true in the case of minor victims. According to service providers and law enforcement, when working with minor victims, in particular international minor victims, there are often numerous individuals involved in a case, making coordination and communication difficult. In some cases, providers and law enforcement report not knowing who to contact on behalf of the minor or who could make decisions on behalf of the minor. There were cases of information not getting transferred from one agency to the next, sometimes resulting in minors not getting the services they needed. As one provider states, “When the process for [international] minor victims works, it works well. But when it doesn’t, it fails miserably.” There is agreement among providers and law enforcement alike that there needs to be more information and communication regarding how international minor victims are served. Most providers report positive experiences with the URM programs but communications from these programs, as well as the availability and location of services are seen as limited.

V. Innovations and Promising Practices to Serving Victims

To address the many challenges and barriers to providing services to victims of human trafficking, many service providers have developed innovative strategies and promising practices for their agencies and their clients.

Collaboration. The importance of collaboration in meeting the needs of victims of human trafficking cannot be overstated. Law enforcement and service providers stress the importance of working together to meet the diverse and complex needs of this population. The establishment of coalitions and task forces, such as the ORR-funded Rescue and Restore coalitions, is viewed as one strategy that has resulted in the increased availability of services for all victims.

“We have partnered with Goodwill and other similar organizations to obtain vouchers for our clients. They are able to use these to shop for necessities. It provides them with what they need as well as gives them some level of independence.”

Service Provider

Several service providers report establishing formal memoranda of understanding (MOUs) with domestic violence shelters to ensure not only placement of their clients but placement in a facility with a staff trained on human trafficking and sensitive to the needs of victims. These MOUs are also important because some domestic violence shelters will not (or cannot) accept victims if they are not victims of domestic violence, defined as involving a boyfriend or spouse. But with MOUs, exceptions to this definition have been made with some agencies. Service providers also report success in reaching out to domestic violence shelters that traditionally serve battered immigrant women.

In several communities across the country, collaboration among local law enforcement, juvenile and family court judges, child protection services, and youth shelters and programs has proven to be a promising and necessary practice for identifying and meeting the needs of domestic minor victims of sex trafficking.

Consistent Case Managers. Given the complexity of victims’ needs and the comprehensiveness of the services provided, service providers, law enforcement, and victims report that having a consistent case manager all the way from identification to case closure is a promising practice.(7) While not possible in all cases due to staff turnover and the lack of funding for case managers for domestic victims, having this consistency benefits the victim, service providers, and law enforcement (including prosecutors). A central case manager with knowledge of all aspects of the victim’s situation can ultimately save time and resources.

“Victims need to be assigned a case manager from point of identification throughout the criminal justice process. This person does not need to be a victim witness coordinator from law enforcement (although they could) but the person needs to be consistent.”

Law Enforcement

Mobile Services. In some communities, home visits that provide medical and mental health care, and basic case management, is an innovation helping to meet the needs of victims. This approach is especially valued by agencies serving clients in large geographically dispersed areas, as well as rural areas. In both of these cases, clients can find it difficult to get to their appointments. Some service providers mention using in-home visits as a way to introduce clients to services; it is almost a trial period before transitioning them to in-office treatment.

Additionally, linking clients to existing mobile health clinics is a common practice for many agencies, including shelters working with domestic victims.

Use of Pro Bono Services. Several agencies report using pro bono services, particularly for legal services. This often involves providing training to attorneys on the issue of human trafficking and providing access in order to interview clients. While this results in a larger pool of affordable and appropriate service providers for clients, it does require significant training and monitoring according to providers. One example of where this approach has worked well is Project Liberty, highlighted in the box below.

Volunteer Programs. Some agencies establish programs where their clients can do volunteer work. Because many victims are unable to do regular work until they receive their work authorizations, service providers need to find ways to use this “waiting period” to help engage their clients in the community and workplaces, when appropriate. Several providers have in place volunteer programs where clients gain valuable on-the-job training that can then result in quick placement in a job with the same or similar agencies.

VI. Summary

The needs of victims of human trafficking, whether international or domestic, can be characterized as complex, requiring comprehensive services and treatment that span a continuum of care from emergency to short-term to longer-term assistance. Providing these services can take months or years; the timeline for serving each victim is

different and often unpredictable. The challenges associated with accessing timely and appropriate services for victims are ongoing. But through collaboration among agencies, including non-governmental organizations, shelter providers, health care providers, law enforcement and others in communities across the country, and through innovative strategies and promising practices, there are more services available today for victims of human trafficking than at any time in the past. And while there remains room for improvement, particularly regarding adult domestic victims, the services available to victims of human trafficking appear to be better tailored to their needs than they have been in the past.

Building Bridges Between Domestic Violence Organizations and Child Protective Services

Linda Spears


I am first and foremost grateful to all who participated in the preparation of this paper for their commitment to the principles of collaboration between domestic violence and child protection. Their skill in working together allowed me to write a paper that reflects these values both in its content and its preparation.

My deepest gratitude is extended to Susan Schechter, of the University of Iowa School of Social Work, for her thoughtful guidance in conceptualizing and completing this work. I am equally grateful to Jill Davies, of Greater Hartford Legal Assistance, for authoring the case narrative and for her substantive edits to the documents. Their efforts brought greater clarity and utility to the paper. I would also like to thank my colleagues for their contribution of source materials and their review of the many drafts along the way. Their creative energy and technical assistance were invaluable. Chief among them are The Honorable Len Edwards of the Santa Clara County Superior Court; The Honorable Bill Jones of the District Court of Charlotte, NC; Merry Hofford of the National Council of Juvenile and Family Court Judges; Janet Carter of the Family Violence Prevention Fund; and Lonna Davis and Pamela Whitney of the Massachusetts Department of Social Services.

I would also like to acknowledge the leadership of Anne Menard, at the National Resource Center on Domestic Violence, under whose auspices this document was developed.

Finally, I am deeply appreciative for the support of The Ford Foundation, whose continued commitment to ending family violence made this work possible.

About The Authors

Ms. Spears is the Director of Child Protection at the Child Welfare League of America, where she directs both its national child protection reform initiative Protecting America's Children: It's Everybody's Business, and the City/County public child welfare efforts. Prior to joining CWLA in 1992, Linda served as the Director of Field Support with the Massachusetts Department of Social Services. As a member of the department's senior management team, she was responsible for agency-wide services in family preservation, child protection, domestic violence, out-of-home placement, permanency planning, child care, independent living, substance abuse, and housing.

While in Massachusetts, Ms. Spears led an effort to better integrate the expertise of domestic violence advocates with the work of child protection caseworkers. She is a member of the board of directors of the Family Violence Prevention Fund, on the advisory committee of the National Resource Center on Child Maltreatment, and an advisor to the National Resource Center on Domestic Violence, Child Protection and Custody.


I.    Introduction

II.    Why Must Domestic Violence Advocates and Child Protection Staff Work Together?

III.    What Effects Does Domestic Violence Have on Children?

IV.    How Does the Child Protection System Work?

  1. How Did the Child Protection System Begin?
  2. How Do Cases Move Through the Child Protective Agency?

V.    How Can Domestic Violence Organizations and Child Protection Agencies Collaborate?

  1. Examples of Current Domestic Violence/CPS Collaborations
  2. What Would a Collaborative Response Look Like?
  3. Principles for Domestic Violence-Child Protection Collaboration

VI.    Conclusion


Violence against women and children is centuries old, but only over the past 25 years have communities made significant improvements in their responses to each problem. In the 1970s, state legislatures created systems to help abused children, and by the 1980s many grassroots women's organizations had set up shelters for battered women. These two response systems were designed with very different mandates, funding, and goals. As a result, tensions and problems now emerge as service providers, the courts, and communities try to more effectively help those families in which violence against women and children is overlapping and intertwined.

Domestic violence advocates have learned that the concerns of battered women are inextricably linked to the welfare of their children and that the safety decisions of battered women are typically guided by the needs of their children.

As a result, domestic violence organizations have worked hard to address the needs of the children of battered women, including providing a variety of concrete services like children's play and educational groups, support activities, and therapeutic services. Advocates have also broadened the scope of their work to include case-level and systemic advocacy for children.

Over the last ten years, domestic violence advocates have learned that it will take a coordinated effort to effectively protect women and their children. No single organization can do this work by itself. Without collaboration and coordination among agencies, it is the battered women and their children who pay the price: their safety is jeopardized and their needs for security and stability are compromised.

"Building Bridges Between Domestic Violence Organizations and Child Protective Services" was prepared as a new resource for advocates seeking to strengthen efforts to help battered women with abused and neglected children. This paper provides both background information and a framework for collaboration with child protection agencies that will support the work of domestic violence advocates as they try to improve safety for women and their children.

The paper covers the following topics:

  • Why must domestic violence advocates and child protection staff work together to keep battered women and their children safe?
  • What effects does domestic violence have on children?
  • How does the child protection system work?
  • How can domestic violence organizations and child protection agencies collaborate effectively and respond to policy challenges constructively?


Last night Gina's boyfriend Mark came home drunk again. They started arguing about money, and Mark slapped and punched Gina. Seven-year-old Sammy ran into the kitchen and started hitting Mark and yelling, "Stop hurting my Mommy!" Mark picked Sammy up by the seat of his pants and yelled, "Stay out of this, you little bastard, you're just like your father - a real loser." He then dropped Sammy, who crashed to the floor. Sammy started crying, and Gina yelled at him to get out of the kitchen. Gina and Mark's one-year-old daughter Jessie started crying in the other room. Mark told Gina to just "let her cry, or she'll grow up to be a stupid baby like you."

A neighbor called the child abuse hotline to report that there was fighting in the apartment next door and that she could hear the children crying again and worried that they were being hit.

Gina's situation is all too familiar to domestic violence advocates and child welfare workers. A woman is the victim of physical assaults and verbal abuse. Her children's lives are altered by her situation - their well being, and often their safety, are compromised by the actions of an abusive partner. Sometimes, before the woman can fully consider the alternatives available to her, she is reported to child protection authorities because neighbors, friends, or service providers are concerned that the risk to her children is too great. Soon, she finds herself meeting with a child protection caseworker whose assessment of her situation could result in the removal of her children.

The actions of the police, child protection workers and others can have a tremendous impact on the immediate and long-term safety of both Gina and her children. However, domestic violence advocates and child protection workers might start from different places of emphasis. For example, advocates considering Gina's situation might focus on the following questions:

  • How does Gina view the risks to herself and her children? What supports and resources does Gina have available to help her keep herself and the children safe? What is her current safety plan? Will it be effective, or does she need additional information and resources?
  • How dangerous is Mark? Does he understand how he is hurting Gina and the children? Has he ever been arrested for his violent behavior? How did he respond? Will he obey court orders?

A child protection worker might focus on these questions:

  • What happened on the night of the incident according to Gina, her children, and the neighbor? Was Sammy physically injured when Mark dropped him? If so, did Mark or Gina make sure he got medical attention? Has this happened before? Has Mark every hit Sammy or Jessie?
  • What steps has Gina taken to protect the children? Can Gina protect the children? Are there other indications that the children are neglected or abused or at serious risk of harm?

Once advocates and caseworkers answer these questions, each will begin a series of activities to help family members achieve safety. These efforts are likely to help some family members. For example, a battered woman's shelter will provide safety for mother and children in the short term. However, once the shelter period is over, lack of resources may send her back to an abusive partner, placing her and the children at renewed risk.

At the same time, foster care placement - arranged through the child protective system - can provide safety for the children, but it may not be needed or desirable if the mother is able to provide for their care. Even if she can't, foster care does nothing to address her safety concerns.

Family preservation workers can also provide a valuable resource to the family, with frequent home visits to provide help and monitor the safety of mother and children, even if the abusive partner returns. But this intervention can be problematic if the family preservation worker does not have strong skills in handling a domestic violence situation.

Finding strategies that help both women and children to be safe is a dilemma that challenges domestic violence advocates and child protection workers every day. Despite mutual interests, those working with battered women and their children find that not all approaches are useful in achieving safety for all victims. Some approaches don't last long enough. On occasion, interventions to help one victim - giving the mother time to develop a plan - might actually increase the risk to another group of victims, the children.

When advocates and child protection workers are able to effectively assist women and children, it is likely that they have done so by coordinating safety assessments and interventions for both the mother and child. Together, they have also found ways to better understand how services for battered women and their children work, and how these services can work together. This has meant sharing vital information about the differing laws that guide domestic violence advocates and child protection caseworkers, the values and principles that guide their responses, and the tools and resources that are available in each system.

For advocates, collaboration can mean a significant and positive change in their work on behalf of women and children. Child protection workers are not experts in domestic violence. Typically, they must have general casework skills to deal with a variety of family needs. Only a few workers have training opportunities that would allow them to develop expertise in the dynamics of battering and its impact on children. While most are familiar with local battered women's shelters, they often have limited information about the range of related services and supports that are available through advocates, the courts, and other systems. Domestic violence advocates can change this through collaboration.

Likewise, advocates can be frustrated in their interactions with a child protection system whose powers are substantial and whose rules may often seem arbitrary and subjective. Collaboration can help unravel the complexity of the child protection system to reveal ways in which advocates can work effectively with child protection workers to keep both battered women and their children safe.


Author's Note: CPS is the acronym commonly used to denote the public agency designated by statute to investigate reports of child abuse and neglect. In this paper, the terms cps, child protective agency, and child protection agency are used interchangeably. The term child protection system is used to denote the broad network of partners with critical roles in child protection including the legal system, the cps agency, and other service providers.

For advocates to collaborate effectively with child protection workers, the latter must have a basic understanding of the effects of domestic violence on children.

For more than a decade, researchers have examined the impact of children's exposure to domestic violence. This body of data supports the experience of women like Gina. Most children who live with domestic violence witness it in some form, and this experience may cause harm. These harms include those that result when:

  • children experience their mother being battered and also see injuries that result from the violence;
  • children are injured during a violent episode; this may occur inadvertently when a batterer attacks, a victim tries to defend herself or the children, or the child tries to protect a parent; or
  • children are directly abused or neglected.CEU

While effects on individual children may vary, researchers have concluded that many children who are exposed to violence exhibit at least some symptoms related to this experience. These symptoms might include fearfulness, sleeplessness, withdrawal, anxiety, depression, and externalized problems such as delinquency and aggression.2

Research also suggests that these problems are often alleviated when children and their mothers are offered adequate social, emotional, and material support and safety.

The Overlap of Domestic Violence and Child Maltreatment

Through their work with women like Gina, front-line workers in domestic violence and child protection agencies are increasingly aware that when there is child maltreatment there is often domestic violence. Data from research and from direct practice in shelters and in child protective service programs are supporting their experience.

In one nationwide survey of 6,000 families, researchers found that 50% of men who frequently assault their wives also frequently abuse their children.In a 1991 Boston City Hospital study, researchers reported that 59% of mothers of abused and neglected children had medical records that suggested that their partners had battered them.

Although there is little formal research on domestic violence in child protection caseloads, some data support a link between domestic violence and child abuse and neglect. For example, in a 1990 review of substantiated child protection cases, the Massachusetts Department of Social Services reported that workers noted domestic violence in 30% of the cases.Because the agency did not prepare or require caseworkers to consider domestic violence in the investigation and assessment process, the study was believed to underestimate the actual incidence of domestic violence. In a subsequent study, conducted after implementing policies and training in domestic violence, the Department found that in 48% of records reviewed workers identified domestic violence or cited "protecting an adult from domestic violence" as a goal of service.

As with any case type, domestic violence cases can range from those where child maltreatment is highly unlikely to those in which there is serious or life threatening harm to children. Thus far, several other child protection agencies have documented a disturbing link between domestic violence and fatal child abuse. In 1993, the Oregon Department of Human Resources reported that domestic violence was present in 41% of families experiencing child abuse and neglect resulting in critical injuries or death.The Massachusetts Department of Social Services made a similar finding when a 1994 review of child abuse- and neglect-related fatalities revealed that 43% of mothers identified themselves as victims of domestic violence.In New York City between 1990 and 1993, the public child welfare agency found that 55.6% of the families with child homicides had a documented history of domestic violence in the four years preceding the fatality.

Although we are learning more about the connection between domestic violence and child maltreatment, we still know little about how the two interact within the family. There is no evidence, for example, that fatal child abuse is more likely to occur where there is domestic violence. A better understanding of domestic violence will help child protection workers to best target their interventions. Also, if advocates and child protection workers strengthen their knowledge and skills in assessing the risk to children, they will be better able to reduce the number of children and women experiencing serious harm.

The child protection movement began more than 100 years ago and galvanized around a highly publicized New York City case involving a young child, Mary Ellen, who was brutally beaten by her caretakers.

This case led to the creation of the first child protection agency and state statute providing agents to conduct court investigations into child maltreatment.Early activists sought protection for children and punishment for abusers. As the child protection movement evolved, new mechanisms emerged to support this work including:

  • the first juvenile court, in Illinois, in 1899;
  • a federal oversight agency - The Children's Bureau - which still exists today; and
  • the Social Security Act in 1930, which provided the first national directive and funding for child welfare services.

Each of these events was critical in the development of the nation's child protection system. Nonetheless, much of our modern system has emerged over the last 37 years, beginning in 1962, when Dr. C. Henry Kempe identified the "battered child syndrome." His work resulted in the first broad public awareness of child abuse and neglect.

Since then, both state and federal governments have been proactive in their response creating new legislation to direct child protection efforts. Throughout this period we have seen dramatic increases in the number of children and families served, the array of services, and the scope of legal requirements guiding the system. The key components in our current system are highlighted in the following table.


TABLE 1: Key Features of the Child Protection System

Federal Legislative Framework

  • Child Abuse Prevention &Treatment Act of 1974
  • The Indian Child Welfare Act of 1978
  • Adoption Assistance & Child Welfare Act of 1980
  • The Adoption & Safe Families Act of 1997

Primary Service Mandate

  • Safety for children

Secondary Service Goals

  • Permanency for children by strengthening family or seeking alternative permanent families. (e.g., adoption)
  • Well-being of children

Service Providers

  • Government agencies providing statutorily mandated services
  • Contracted and community services used to reduce risk & address family problems

Support and Authority Used to Assist Victims

  • Child protection worker responsible (through state statute) to monitor families and offer supportive services
  • Supportive & authoritarian roles also carried by community agencies and police/courts, respectively

Examples of Services and Tools Used to Respond

  • Child Abuse and Neglect Hotline
  • Joint police & child protective services response including investigation & assessment
  • Shelter, kinship, and foster care placements
  • Treatment services like parenting classes, substance abuse treatment & counseling
  • Case management & referral
  • Temporary & permanent custody of child

Court Role

  • Juvenile or Family Courts provide protection (e.g., legal custody) & oversee decision-making of CPS
  • Criminal Courts used in a few extremely serious cases.


Federal statutes that guide child protection agencies

While child abuse and neglect laws vary from state to state, they all must comply with the basic requirements established in the following federal statutes:

The Child Abuse Prevention and Treatment Act of 1974 (CAPTA).
The act required that each state establish a mandatory reporting system for child abuse and neglect. Through a series of revisions, the most recent of which became law in 1996, the act has established detailed criteria for state programs receiving the limited funds available under the act. These include provisions guiding the definition of abuse and neglect in state statutes; requirements for confidentiality for children and families; immunity for individuals who report abuse and neglect; and provisions requiring guardian-ad-litems for children.

The Indian Child Welfare Act of 1978 (ICWA).
This act establishes the jurisdiction of Indian tribes in child custody cases involving Indian children. The act provides specific procedures for the timely notification of tribes when Indian children come to the attention of child welfare agencies and placement is being considered, so that tribal membership can be determined..

The Adoption Assistance and Child Welfare Act of 1980 (P.L.96-272).
This act establishes procedural safeguards for children to try to ensure that they do not linger in foster care. As amended in 1983, the act establishes administrative and judicial case review to try to ensure that the protective and "best interests" needs of children were met. The statute also requires child welfare agencies to make reasonable efforts to prevent placement and provide services to reunify families. The statute also supports agency programs to secure an alternative permanent family when reunification is not possible.

The Adoption and Safe Families Act of 1997 (ASFA).
This act is broad in its scope, addressing family preservation, child protection, permanency planning, and adoption concerns. Among its key provisions is a focus on child safety as the first priority in child welfare decision-making. It also calls for states to pass legislation detailing specific criteria for timely permanency planning in all cases and expedited termination of parental rights in cases of extreme child abuse and neglect.


Core values of the Child Protection System

The principal purpose of a child protection service is to protect children whose parents or caregivers are unable or unwilling to provide for their safety, basic needs, and emotional security.11Within this framework, it is understood that children are not able to protect themselves and that those who act on their behalf must be guided by what is in the child's best interests. The following values hold true:

  • Every child has a right to adequate care, supervision and freedom from maltreatment.
  • Every child should have a safe permanent family.
  • Parents have the primary responsibility and are the primary resource for their children.
  • In most circumstances, the most desirable place for children is in their own safe and caring family.
  • Most parents want to and can be adequate parents.
  • Most parents experiencing difficulty can be helped to be adequate parents.
  • When parents cannot or will not fulfill their protective responsibilities, the community has the right and obligation to intervene.

Once the child welfare agency intervenes to protect a child, two key principles guide its work:

1. Safety is always the first consideration in determining how the best interests of a child will be met.
2. The child's wellbeing and need for a more permanent family are also critical considerations.

At a casework level, this typically means that when it can be done safely, services must be provided to strengthen the parent's ability to provide a safe and permanent home for the child. Whenever safety cannot be assured while the child is at home, placement outside the home is made and services are geared at strengthening the family so that the child may be returned home. When this cannot be accomplished in a reasonable timeframe, the agency must look quickly to other resources, including relatives and adoptive families, to provide a permanent family for the child.

The basis for this approach can be found in both state and federal statutes. At the state level these laws may also provide more specific guidance to caseworkers by outlining timelines for key decisions and criteria for certain agency actions. For example, statutes often prescribe the number of days within which a child abuse investigation must be completed and sometimes detail what contacts or assessments are required in order to complete an investigation. States vary widely with regard to the specificity of their child abuse laws and policies. Advocates seeking to collaborate should become familiar with their state statute, and with related state and local policies.

B. How do cases move through a child protective agency?

The following chart provides a brief description of the flow of cases through the typical child welfare system.


What happens during CPS intake and screening?

To best describe how the child protection system operates, let's return to the report filed regarding Gina and her children. Before a visit was made to her home, the child protection agency "screened" the report made by the neighbor to determine how it should be handled. Often this means answering only a few simple questions. First, if the allegation were true as reported, would it constitute abuse or neglect according to the state law? Second, is the report credible? In Gina's case the intake worker "screened in" or accepted the report, believing that it was reliable and that Gina's children may be at risk. Had the worker found otherwise, the report would be "screened-out." At that point, it would typically be closed or referred to another agency for assistance.


What happens during an investigation or assessment?

Once a case is screened in, the child protection caseworker begins an assessment of the situation. This assessment or investigation typically begins with an interview of the parents and children that is usually conducted in the family home. During this interview, the worker tries to determine what has happened, and whether or not the children are at immediate risk. [See Appendix A for a more a detailed description of the CPS investigation and assessment process.]

After receiving the hotline report, a child protection caseworker met with Gina and her children to begin an assessment. The worker learned that Sammy and Jessie are Gina's only children and that Sammy's father is Gina's ex-husband, who does not live in the area. Gina talked freely about the current incident and said she yelled at Sammy to leave the kitchen so he wouldn't get hurt.

Although Sammy was not hurt this time when Mark dropped him, he and Jessie are afraid of Mark. Mark has never hit them, but Gina is afraid that if she leaves Mark alone with them he might. Gina also told the worker that the one time Mark came home really drunk, she and the kids stayed at a friend's house overnight. Gina also reported that Sammy and Jessie sometimes had difficulty sleeping after an episode of abuse and that she is really worried about them.

A separate interview with Sammy corroborated their mother's account of the incident. The children also stated that they were afraid of Mark and that they worried about their mother. Sammy is upset because his Mother yelled at him to leave the kitchen that night and he didn't know what to do. He went into Jessie's room to try to get her to stop crying. When Mark is in a "bad mood," Sammy says, his mother tells him to stay in his room.

The interview with Mark was very brief. Mark admitted to having a "few too many" but dismissed the rest of the allegations as just the "fantasy world of a busybody neighbor."

In instances like Gina's, the caseworker will also talk with the neighbor to confirm her report and might contact the police to gather information about their history of calls to the home. In addition, the caseworker might contact a daycare center, school, or pediatrician for additional information about the family.

Based on this information, it is the caseworker's responsibility to make several determinations.

  • Is there reason to believe that the allegations of child abuse or neglect are true? State law sets the legal standard against which this is measured. Typically, evidence does not have to "be clear and convincing" but there must be "reasonable cause to believe" that allegations are true. The answer to this question determines whether a case is substantiated (also called "founded").
  • What, if any, risk of harm to the children currently exists and what is the likelihood that they will be at risk in the future? This assessment of current safety and future risk usually helps a worker to determine what, if any, services will be provided to the family. Cases where the risk is believed to be minimal are usually closed, unless the agency and family agree to services on a voluntary basis.Low to moderate risk cases may receive in-home services designed to support the family, improve parenting, and ultimately lower the risk of future abuse and neglect. Higher risk cases often result in either intense monitoring through in-home services or in the removal of the child from the family to achieve safety.

The worker decides to substantiate a finding against Mark because of the risk created when he gets drunk and violent. The caseworker believes that Gina has not intentionally harmed her children and that she has made efforts to protect them. The worker is concerned about Mark's ongoing violence against Gina and its effects on the children. The worker has agreed not to remove the children on the condition that Mark remains out of the home. At this point the caseworker opens a case for in-home services and begins a more in-depth assessment of the family's service needs.

What happens during the assessment and service planning phase?

Once an initial investigation or assessment is completed, the child protection worker is responsible for continuing to gather information about the family and to determine what services are needed.

As the worker spends more time with Gina, he finds out the following: Gina moved to this community two years ago. She and Mark began dating right after she moved. At first, he was very kind to her and to Sammy, helping her get settled and taking Sammy to ball games. He convinced Gina they would "be a family" if she let him move in. As soon as she became pregnant, things got bad. Mark starting drinking more and he would fly into rages, destroying property and attacking Gina. She wanted to ask him to leave, but she quit her job when she became pregnant with Jessie and now relied on Mark for financial support. Mark's parents have also been supportive, and she's worried that if she asks him to leave, she'll lose contact with them. The worker is now also convinced that Gina is severely depressed and may have an alcohol problem.

The worker tells Gina she must get a protective order to assure that Mark can not legally come back to the apartment and that she must get an alcohol and psychological evaluation.

At this point the worker has begun the process of planning services. The service plan will later be written down and signed and will outline the types of resources clients must access and the requirements they must address.

What is the role of the legal system in child protection?

Juvenile and Family Court Proceedings

The caseworker drops by Gina's home to see how she and the kids are doing. Gina, obviously drunk, answers the door. The worker can see that the apartment is in disarray and can hear Jessie crying. She asks to see the children. Gina tells her to go away and to leave her family alone. As the worker heads back to her car to call for help, she sees Mark standing in the back yard.

Gina will no longer talk to the caseworker, so the caseworker decides that the children must be removed from their home in order to be safe. She begins the paperwork to get a court order giving the CPS agency the authority to take Sammy and Jessie out of their home and place them in foster care.

During the initial hearing, however, the judge decides to place Jessie and Sammy with Gina, on the conditions that she comply with the recommendations of the substance abuse evaluation and treatment program and that Mark move out and also attend a substance abuse and batterer intervention program.

Nationwide, only about 15% of children in substantiated abuse and neglect cases are removed from their homes.As a result, the court is not involved with most children who come to the attention of the child protection agency. Nonetheless, the court plays a critical role in certain circumstances. First, court intervention is needed when an investigation and assessment indicate that a child cannot remain at home safely. In these instances, the court's authority is required to take legal custody of the child so that placement and other services may be provided to protect the child. In certain limited circumstances, the child protection agency may place a child out of the home voluntarily with permission of the parent. Policies governing voluntary placements vary across jurisdictions, but even these placements are subject to juvenile court review after six months.

In many jurisdictions, the court may also be involved and allow the children to remain at home with the parent. In these cases the court may oversee the safety of the child and the parents' compliance with the case plan agreement either through an order of supervision or by taking legal custody of the child.

When court intervention is needed, federal and state statutes guide the court in overseeing the protection of children.These oversight responsibilities include assuring that:

  • the child protection agency has made reasonable efforts to prevent the removal of the child from the home;
  • there is a sufficient basis for state intervention on behalf of the child;
  • the child is adequately represented;
  • each parent has received adequate due process including notice; representation; and the right to be heard, present evidence, remain silent and appeal;
  • a proper case plan has been prepared for each parent;
  • the child protection agency has either made reasonable efforts to reunite the child with the family once placement has occurred, and/or the agency has documented that reasonable efforts are not warranted because reunification would be detrimental to the safety of the child;
  • each case is reviewed regularly by the court to ensure that the child's need for a permanent family is addressed in a timely manner; and
  • the child protection agency has made efforts to find a permanent home when the child cannot be returned home.

The courts also play an integral role in decision-making in child protection. Key steps in the court process include:

The Petition. In most states, child protection workers cannot, on their own authority, remove children from their home. They must rely on the authority of either the police or the courts (or in a few cases medical personnel). Even when a child is removed without a court order, the child protection agency is required to file a petition with the court based on timelines established in state law (typically 72 hours or less following removal). The petition contains facts about the alleged abuse or neglect and provides the basis for juvenile court involvement.

The Initial Hearing. This is a critical point in the child protection process. During this hearing the court will decide whether or not the allegations in the petition support the need to remove the child or continue a temporary custody order to protect the child. It is also at this hearing that the court ensures that parents have an attorney to advocate for their rights in the process and that a guardian ad-litem (or alternatively a Court Appointed Special Advocate - a CASA) is appointed to ensure that the child's best interests are addressed.

Adjudicatory Hearings. These are held to determine whether or not the petition is true - i.e., the child has been abused and neglected - and whether the child should be declared dependent - i.e., whether custody or supervisory authority should be removed from the parent and transferred to the court or the child protection agency.

Dispositional Hearings. These are held so that the court may decide what action should be taken after the child is declared dependent. Choices may include returning the child home with supervision from the child protection agency, out-of-home care, and orders for service to the parents and children.

Review Hearings. Following the dispositional hearing, the court typically sets a date(s) to review the status of the case, including the case plan, the parents' progress in meeting the requirements of the case plan, and recommendations for changes in the case plan, the child's placement or custody.

Permanency Hearings. These are held so that the court may establish a permanent plan for the child. This hearing also considers information documenting the current status of the case in determining how and when the child's need for a safe and permanent family will be met. New requirements established in the Adoption and Safe Families Act of 1997 require that a permanency hearing be held within 12 months of a child's entry into care (and at 15 months for children already in care). This requirement puts an enormous burden on battered women to make quick and effective safety plans for themselves or else run the risk of losing their children permanently.

Once the court is involved, the number of people involved in the case can increase dramatically. In addition to family members, the child protection caseworker, service providers, and the judge, legal counsel represents each of the parties to the case. This means that one or more attorneys will represent the parents. The child protection agency will also be represented. Finally, the court will assign a guardian-ad-litem (an attorney) and/or a court appointed special advocate for the child. With these participants, and through this process, the case plan, services to family members, and, ultimately, the outcome of the case are decided.

Law Enforcement

Law enforcement plays an integral role in the protection of children from child abuse and neglect. In nearly all jurisdictions, police share responsibility with the child protection agency to receive and respond to reports of child maltreatment. In so doing, they carry two primary roles. First, they are responsible for the immediate protection of the child - particularly in cases where there is an imminent risk of harm. In many cases, this includes the authority to take protective custody of the child to ensure safety. Second, police are obligated to investigate child abuse and neglect when a crime may have been committed. In many jurisdictions, these investigations only occur when children have been killed or seriously injured as a result of abuse or neglect, when there is sexual abuse of a child, or when there is evidence of other criminal activity by the parent or caretaker.

An additional role for law enforcement is the safety of service providers. In many jurisdictions, police provide protection for caseworkers when they are entering a potentially dangerous situation.

Each of these responsibilities is carried out in coordination with the child protection agency. While many jurisdictions operate informally, in some states, statute or policy requires formal agreements between child welfare and police. Cross reporting of cases between the police and child protection may be mandated to ensure that cases are appropriately investigated and services provided. Jurisdictions may also establish protocols for joint investigations to ensure that the work of the two agencies is coordinated, to minimize the trauma of multiple interviews for children, and to ensure that juvenile and criminal court actions are coordinated.

Several communities across the country have already built collaborations that address domestic violence and child maltreatment collaboratively. Among these are:


The AWAKE Program.

Located at Children's Hospital in Boston, Massachusetts, this strengths-based and family-centered program was one of the first to make the link between domestic violence and child protection. Offering counseling, support groups, and advocacy to battered women with abused and neglected children, the program successfully promotes safety for mothers and children. In 16-month follow-up with a group of 46 mothers served by advocates, 85% of the women reported they were free from violence, and in only one family had children been placed in foster care.


Massachusetts Department of Social Services.

This practice integration model has brought domestic violence expertise to traditional child protective services through a statewide program in which domestic violence specialists work hand-in-hand with child protection caseworkers. The specialists provide case consultation, direct advocacy, and linkages to community resources for battered women and children served by the child welfare agency. Policy guidance supports decision-making that is responsive to the concerns of battered women beginning with screening and investigation and including risk assessment, family assessment, case planning and service delivery.


Michigan's Families First Domestic Violence Collaboration Project.

This cross-system collaboration between shelter programs and family preservation programs is offered in eleven communities across the state. The program provides intensive services designed to keep children safe and with their mothers. The program has also provided models for cross-training that integrate principles from family-centered practice, child protection, and domestic violence.

These three pioneering programs are among a growing array of models that are serving battered women and their abused and neglected children (see Appendix B for suggestions about building positive collaborations).

In Jacksonville, Florida, and Cedar Rapids, Iowa, child protection and domestic violence programs are working together in community partnership models. In San Diego and Minneapolis, hospital-based programs are in place, and partnerships among police, hospitals, and child protection are developing. In Hawaii, Healthy Start programs are combining early intervention for children with screening and intervention in domestic violence. [For more examples, see Family Violence: Emerging Programs for Battered Mothers and their Children, published in 1998 in Reno, Nevada, by the National Council of Juvenile and Family Court Judges.]

B. What Would a Collaborative Response Look Like?

The following scenario provides one example of how domestic violence advocates and CPS workers could collaboratively respond to families in which there is domestic violence and risk to the children. This particular example, rather than neatly solving the complex issues in such families, shows a process through which advocates and workers provide ongoing resources to the adult victim, while taking actions necessary to protect the children.

When Gina talked with her caseworker about Mark's violence, he told Gina about a collaborative program between the local domestic violence shelter program and CPS. Gina agreed to participate, and the worker called the shelter to let them know that Gina would call that afternoon. When Gina called, an advocate talked with her to get a basic understanding of her situation and needs and then set up a time to meet with Gina the next day. Gina told the advocate that she believes Mark could be a good partner and father to Sammy if he didn't drink. She also admitted that she probably drinks too much and just doesn't seem to have "any energy anymore." The advocate talked with Gina about Sammy and Jessie. She validated Gina's efforts to keep them out of the way, but also tried to make sure that Gina understood how the drinking and the abuse affect them and what actions CPS must take if the kids are in danger. They talked about what Gina thinks will keep her and the kids safe.

After getting Gina's permission to talk to the worker, the advocate called the worker, and they developed a plan to propose to Gina and to Mark. The proposed plan called for the following: Mark would move out of the apartment, go to a substance abuse/batterer intervention program sponsored by CPS, pay child support, and visit with Jessie while his parents supervised. Gina would attend counseling to address her substance abuse and depression and would bring Sammy to a children's group run by the shelter. After 6 months, CPS would reevaluate the potential danger to Sammy and Jessie. Both parents agreed to this plan.

After six weeks of attending classes, Mark stopped going. He also told Gina he wasn't going to pay child support for a child he only sees once a week. Desperate for money and tired of single parenting, Gina invited Mark to move back in.

The CPS worker was notified about Mark's lack of attendance. The worker called the domestic violence advocate to let her know, and went out to check on Sammy and Jessie. The advocate also contacted Gina to see how she might help.

C. Principles for Domestic Violence-Child Protection Collaboration

Successful collaboration requires a shared framework for the response to battered women and their children. Core principles already guide collaborative efforts in communities across the country. The following discussion explains each principleand raises key policy challenges that face advocates and child protection workers as they practice together to keep children and their battered mothers safe.

Principle 1:    The safety of children is the priority.

Every procedure, policy or practice of an integrated response to child maltreatment and domestic violence must ensure that children are protected. For example, services to support a battered mother's safety and autonomy must not compromise safety for children. Commitment to this principle can provide essential common ground as child protection workers and domestic violence advocates work through the complex issues of building a collaborative response.

Policy challenges raised by Principle 1:

  • Does a child's witnessing domestic violence constitute abuse/neglect?

There is growing consensus that witnessing domestic violence is harmful to children. However, the harm will not be the same for every child, because the level of violence and each child's experience of the violence are different.

Therefore, there is much less agreement about when the harm from witnessing domestic violence is serious enough by itself to constitute possible child abuse and neglect that should be reported to authorities.

While it is clear that situations in which children are physically injured or sexually assaulted during a domestic violence incident should be reported, other situations are less straightforward and require a careful assessment of danger and risk. For most child protection agencies, the threshold for the finding of emotional abuse and even neglect is quite high, and many domestic violence cases, therefore, will be inappropriate for a referral to CPS. Typically, CPS intervention requires independent corroboration that documents that the neglect and emotional harm is significant and is caused by the actions of the parent.CEU

When domestic violence cases fall below the threshold for child protection intervention, community-based services are needed to address the problems that children may experience.


Principle 2:
Child safety can often be improved by helping the mother to become safe and by supporting the mother's efforts to achieve safety.

Child protection strategies should include efforts to enhance a battered mother's safety.

Policy challenges raised by Principle 2:

  • Should CPS routinely assess for domestic violence at intake?

Among many child protection workers and domestic violence advocates there is a great deal of concern about whether or not routine child protection service intake assessment for domestic violence should be done. Child protection agencies fear that this assessment will overwhelm the agency with even more new cases. Domestic violence advocates fear that child protection may fail to address, or, even worse, compromise the mother's safety during the intake process. In reality, assessing for domestic violence is already a part of the investigation and risk assessment procedures for many child protection agencies. There is growing consensus that child protection should develop the skills and protocols needed to effectively assess for domestic violence, to determine which cases require child protection intervention and which should be referred to community agencies, and to offer services that promote safety for mother and child.


  • How do we resolve confidentiality issues in child protection?

Privacy and confidentiality are cornerstones of domestic violence advocacy with battered women. In contrast, child protection agencies are often bound by policies that mean that information contained in safety plans, service plans and case records may be accessible to perpetrators. A batterer may use this information in custody proceedings or to thwart safety plans developed to protect a woman and her children. Confidentiality issues and misunderstandings often hinder collaboration. To avoid unnecessary conflict, advocates and CPS should work together to understand existing policy and look for ways to improve it. Confidentiality policies must balance the CPS's need for information with the battered mother's right to privacy and with advocates' legal/ethical requirements to keep certain information confidential.


Principle 3:
Safety for battered mothers and their children can be supported by holding the batterer, not the adult victim, accountable for the domestic abuse.


By focusing on perpetrator accountability, we open a new range of resources that can protect children - including restraining orders, prosecution of domestic assaults, and batterer intervention programs. By focusing on perpetrator accountability, we are less likely to blame one victim for harm to another. Batterers must be held accountable for their abuse of women and children, and they must have access to services that eliminate violence and that appropriately and safely support their role as parents.

While most would agree with this principle, in practice the issues become more complicated.

Gina, for example, did not hit Sammy or Jessie, nor was she the one who dropped Sammy. In fact, Gina tried to get Sammy to leave the kitchen and get out of Mark's way. However, Gina is also a parent who is responsible for making decisions about her kids' lives. When Gina decided that Mark could move back in, after he dropped out of the substance abuse/batterer intervention program, she made a decision that could place her kids at risk. Her decision to let Mark move back in was based on her need for financial support. It is important to understand that Gina did not decide, "Yes, I want Mark to move back in so that Sammy and Jessie are at risk," but, rather, "I have to let him back in or else we'll be homeless."

Given Gina and her children's need for financial support, she had little other choice but to let him move back in. The key to keeping Gina safe is to look beyond the decision she made to fully understand why that was her decision. As CPS and other agencies make efforts to help Gina and her children meet their financial needs, Gina's responsibility is to accept and work with those who are trying to help her. (In Gina's case, financial independence through employment may take awhile, and she may need temporary support from the government along with opportunities to address her substance abuse and depression.)

At the same time, Mark needs to be mandated back to substance abuse treatment and batterer intervention programs. If Mark is once again living with the children and, as a result, the children are in danger, child protection and the courts may have no choice but to remove them from Gina's care.

Understanding the basis for battered mothers' decision-making about their lives and the lives of their children will provide the information necessary to effectively safety plan with them. Understanding a battered mother's decision-making also points out that strategies to protect children that hold mothers like Gina liable for "failure to protect" - either in juvenile or criminal courts - will be counterproductive. For example, arresting Gina for getting access to Mark's financial support would not make Jessie or Sammy safe, nor would it change her decision, as she believed she had no other choice. Such strategies will actually decrease a woman's options (thereby increasing her danger and her partner's control) and may subject children to unnecessarily being taken from their homes and families.

Policy challenges raised by Principle 3:

  • Decision-making in Child Protection

A decision to substantiate or confirm a report of abuse and neglect is typically made in the context of several key questions: (1) Did the reported incident occur? (2) Is the child at continued risk of harm? (3) Who is responsible for the maltreatment? and (4) Who can protect the child?

The last two questions pose some unique challenges in cases involving domestic violence.

How do we minimize allegations of failure to protect?

When child protection workers substantiate maltreatment, they must typically identify what type of abuse occurred (e.g., physical abuse, neglect, sexual abuse, or emotional maltreatment) and how the parent


Abuse and Women with Disabilities

Margaret A. Nosek and Carol A. Howland

Defining Disability and Abuse

For the purpose of this paper, the term disability will encompass the following impairments: disability that can increase vulnerability to abuse may result from physical, sensory, or mental impairments, or a combination of impairments; physical disability resulting from injury (e.g., spinal cord injury, amputation), chronic disease (e.g., multiple sclerosis, rheumatoid arthritis), or congenital conditions (e.g., cerebral palsy, muscular dystrophy); sensory impairments consisting of hearing or visual impairments; and mental impairments comprising developmental conditions (e.g., mental retardation), cognitive impairment (e.g., traumatic brain injury), or mental illness.

Emotional abuse is being threatened, terrorized, severely rejected, isolated, ignored, or verbally attacked. Physical abuse is any form of violence against one's body, such as being hit, kicked, restrained, or deprived of food or water. Sexual abuse is being forced, threatened, or deceived into sexual activities ranging from looking or touching to intercourse or rape.

Prevalence of Violence Against Women with Disabilities

The prevalence of abuse among women in general has been fairly well documented, yet only a few North American studies (review by Sobsey, Wells, Lucardie, & Mansell, 1995), primarily from Canada, have examined the prevalence among women with disabilities.

The DisAbled Women's Network of Canada (Ridington, 1989) surveyed 245 women with disabilities and found that 40% had experienced abuse; 12% had been raped. Perpetrators of the abuse were primarily spouses and ex-spouses (37%) and strangers (28%), followed by parents (15%), service providers (10%), and dates (7%). Less than half these experiences were reported, due mostly to fear and dependency. Ten percent of the women had used shelters or other services, 15% reported that no services were available or they were unsuccessful in their attempts to obtain services, and 55% had not tried to get services.

Sobsey and Doe (1991) conducted a study of 166 abuse cases handled by the University of Alberta's Sexual Abuse and Disability Project. The sample was 82% women and 70% persons with intellectual impairments, and covered a very wide age range (18 months to 57 years). In 96% of the cases, the perpetrator was known to the victim; 44% of the perpetrators were service providers. Seventy-nine percent of the individuals were victimized more than once. Treatment services were either inadequate or not offered in 73% of the cases.

The Ontario Ministry of Community and Social Services (Toronto Star, April 1, 1987) surveyed 62 women and found that more of the women with disabilities had been battered as adults compared to the women without disabilities (33% versus 22%), but fewer had been sexually assaulted as adults (23% versus 31%).

An extensive assessment of the sexuality of noninstitutionalized women with disabilities, which included comprehensive assessment of emotional, physical, and sexual abuse, was conducted by the Center for Research on Women with Disabilities (CROWD) through a grant from the U.S. National Institutes of Health. This study also covered other areas that may be associated with abuse, such as sexual functioning, reproductive health care, dating, marriage, parenting issues, and the woman's sense of self as a sexual person. The design of the study consisted of (1) qualitative interviews with 31 women with disabilities, and (2) a national survey of 946 women, 504 of whom had physical disabilities and 442 who did not have disabilities. Disabilities reported most frequently included spinal cord injury, cerebral palsy, muscular dystrophy, multiple sclerosis, and joint and connective tissue diseases.

Abuse issues emerged as a major theme among the 31 women interviewed in the first phase of this study. An analysis of reports of abuse in those interviews was described by Nosek (1996). Twenty-five of the 31 women reported being abused in some way. Of 55 separate abusive experiences, 15 were reported as sexual abuse, 17 were physical (nonsexual) abuse, and 23 were emotional abuse.

The findings from the qualitative study were used to develop items for the national survey. Two pages of the 51-page survey were devoted to abuse issues, encompassing more than 80 variables, including type of abuse by perpetrator and age when abuse began and ended, plus two open-ended questions. Analyses of these data (Young, Nosek, Howland, Chanpong, & Rintala, 1997) have revealed that abuse prevalence (including emotional, physical and sexual abuse) was the same (62%) for women with and without disabilities. There were no significant differences between percentages of women with and without disabilities who reported experiencing emotional abuse (52% versus 48%), physical abuse (36% in both groups), or sexual abuse (40% versus 37%). The most common perpetrators of emotional and physical abuse for both groups were husbands, followed by mothers, then fathers. Emotional abuse by husbands was reported by 26% of all women in both groups; physical abuse by husbands was reported by 17% of all women with disabilities and 19% of all women without disabilities. The most common perpetrator of sexual abuse was a stranger, as reported by 11% of women with disabilities and 12% of women without disabilities. Women with disabilities were significantly more likely to experience emotional and sexual abuse by attendants and health care workers. Women with disabilities reported significantly longer durations of physical or sexual abuse compared to women without disabilities (3.9 years versus 2.5 years). In an analysis of sexual functioning, abuse was found to be a significant predictor of lower levels of satisfaction with sex life among women with disabilities (Nosek, Rintala, Young, Howland, Foley, Rossi, & Chanpong, 1995)

Others have reported a history of sexual abuse among 25% of adolescent girls with mental retardation (Chamberlain, Rauh, Passer, McGrath, & Burket, 1984), 31% of those with congenital physical disabilities (Brown, 1988), 36% of multihandicapped children admitted to a psychiatric hospital (Ammerman, Van Hasselt, Hersen, McGonigle, & Lubetsky, 1989), and 50% of women blind from birth (Welbourne, Lipschitz, Selvin, & Green, 1983). In spite of these high percentages, few women receive treatment from victim services specialists (Andrews & Veronen, 1993).

Abuse Interventions for Women with Disabilities

There have been virtually no studies that examine the existence, feasibility, or effectiveness of abuse interventions for women with disabilities. In both the disability rights movement and the battered women's movement, it is generally acknowledged that programs to assist abused women are often architecturally inaccessible, lack interpreter services for deaf women, and are not able to accommodate women who need assistance with daily self-care or medications (Nosek, M.A., Howland, C.A., & Young, M.E. 1998). Merkin and Smith (1995), in discussing the needs of deaf women, state that counseling is more effective when sensitive to deaf culture issues and appropriate communication techniques.

Crisis interventions typically include escaping temporarily to a woman's shelter, having an escape plan ready in the event of imminent violence if the woman chooses to remain with the perpetrator, and escaping permanently from the abuser. These options may be problematic for the woman with a disability if the shelter is inaccessible or unable to meet her needs for personal assistance with activities of daily living, if the shelter staff are unable to communicate with a deaf or speech-impaired woman, if she depends primarily on the abuser for assistance with personal needs and has no family or friends to stay with, or if she is physically incapable of executing the tasks necessary to implement an escape plan such as packing necessities, hiding money, and driving or arranging transportation to a shelter or friend's home.

Andrews and Veronen (1993) list four requirements for effective victim services for women with disabilities. First, service providers need to provide adequate assessment of survivors, including questions about disability-related issues. Second, abuse service providers should be trained to recognize and effectively respond to needs related to the disability, and disability service providers should be trained in recognizing and responding to physical and sexual trauma. Third, barriers to services should be eliminated by providing barrier-free information and referral services, by ensuring physical accessibility to facilities, by providing 24-hour access to transportation, to interpreters, and to communication assistance, and by providing trained personnel to monitor risks and respond to victims receiving services through disability programs. Finally, persons with disabilities who are dependent on caregivers, either at home or in institutions, may need special legal protection against abuse.

The National Domestic Violence Hotline keeps a database of battered women's shelters throughout the country, with indications of their architectural accessibility and the availability of interpreter services. Although the hotline is equipped with telecommunication devices for persons who are deaf, it is rarely used. The National Coalition Against Domestic Violence has issued a manual that gives specific guidelines for battered women's programs on implementing accessibility modifications according to the requirements of the Americans with Disabilities Act and increasing sensitivity and responsiveness among program staff to the needs of abused women with disabilities (National Coalition Against Domestic Violence, 1996).

Critique of Studies on Abuse and Disability

Until recently, the problem of abuse among people with disabilities has received very little attention. Early studies suffered from many methodological weaknesses. Essential constructs and variables important to statistical analysis were rarely defined. There was a particular lack of distinction among emotional, physical, and sexual abuse. The studies used unstandardized measurement instruments and techniques. Global references were made to the type of abuse, for example, emotional versus sexual; however, there was little attempt to document or categorize specific incidents by perpetrator. Samples in these studies were generally quite heterogeneous in terms of disability type, gender, and age. There was also the use of convenience sampling, such as using clients of intervention programs or police reports, as opposed to representative or random sampling. Statistical analyses rarely go beyond frequencies and measures of central tendency. Due to the heterogeneity of the samples, analyzing specific experiences of individuals with specific characteristics (such as sexual abuse among adult women with mental illness) would result in subsamples too small to allow the use of more sophisticated analytic procedures.

The recent study by the Center for Research on Women with Disabilities addressed a number of these issues. It had clearly defined variables; assessed types of abuse, perpetrator, and duration of abuse; sampled a broad range of women nationwide, including an able-bodied comparison group; and was restricted to a defined sample of adult women with physical disability. The issue of designing and implementing appropriate intervention studies for women with disabilities has received no attention beyond observation and speculation.


There is no question that abuse of women with disabilities is a problem of epidemic proportions that is only beginning to attract the attention of researchers, service providers, and funding agencies. The gaps in the literature are enormous. For each disability type, different dynamics of abuse come into play. For women with physical disabilities, limitations in physically escaping violent situations are in sharp contrast to women with hearing impairments, who may be able to escape but face communication barriers in most settings designed to help battered women. Certain commonalities exist across disability groups, such as economic dependence, social isolation, and the whittling away of self-esteem on the basis of disability as a precursor to abuse. Research that employs methodologic rigor must be conducted with women who have disabilities such as blindness, deafness, mental illness, and mental retardation. Particular attention must be paid to identifying vulnerability factors that are disability-related as opposed to those factors experienced by all women.

We must know more about interventions that are effective for women with disabilities. Considerable work has been done in this area for women in general; however, many of the recommended strategies are not feasible for women with disabilities. Few of the strategies listed in classic safety plans are possible for women who must depend on their abuser to get them out of bed in the morning, dress them, and feed them. There are only a handful of programs across the country that specifically address the needs of abused women with disabilities, making controlled intervention studies very difficult.

Much more work must be done to increase the awareness of providers of disability-related services so that they can recognize abuse among their clients and make appropriate referrals to battered women's programs. Correspondingly, much more work must be done to increase the capacity of battered women's programs to serve women with all types of disabilities.

Authors of this document:

Margaret A. Nosek, Ph.D.
Carol A. Howland, M.P.H.

February 1998

Nosek, M. & Howland, C. (1998, February). Abuse and Women with Disabilities.. Harrisburg, PA: VAWnet, a project of the National Resource Center on Domestic Violence/Pennsylvania Coalition Against Domestic Violence. Retrieved 10/4/09



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Battered Women’s Protective Strategies

By Sherry Hamby

With contributions from Andrea Bible

When exploring battered women's protective strategies, the first question to ask is, “Protection from what?” Protection from further violence is a natural and obvious answer to this question, but it is not the only answer. Many other domains of a woman's life are also threatened by battering: her financial stability, the well-being and safety of her children, her social status and the degree to which she is subjected to a stigmatized identity, her psychological health and sense of self-worth, and her hopes and dreams for the course of her life. These are just a few of the areas that are routinely threatened by a woman's abusive partner. Indeed, the threats to these domains may in some cases be greater than the threats of injury or physical pain.

Victims are never responsible for the battering perpetrated against them, but, just as people cope and respond to other negative events, victims must also cope and respond to battering. Few people recognize that women are often attempting to cope with numerous threats posed by battering, not just the threat of bodily harm. Unfortunately, it is not always possible to protect oneself from all of these harms simultaneously, or even to spread the risks more or less equally across these domains. Rather, acts that protect against one form of harm often exacerbate other harms. In particular, the unintended consequences of leaving for battered women and their children, especially leaving abruptly in an emergency context, are under-acknowledged by many scholars and advocates (Davies, 2009). It is perhaps natural to assume that escaping violence as quickly as possible is an obvious choice for any victim. The reality, however, can be much bleaker. Some women are so destitute, both financially and socially, that leaving, especially in a short time frame, may be worse than staying. According to Hamby and Gray-Little (2007):

The dangers of staying with a violent partner may be less than the dangers of living on the streets. The pain of an occasional beating may be less than the pain of losing custody of one's children to a violent parent (p. 28-5).

Many in the general public, and even advocates and scholars with extensive experience in the field of partner violence, may find it difficult to accept that conditions of poverty and social isolation exist for so many women. Nonetheless, assumptions that leaving is always better or safer than staying have meant that people do not always recognize the wide array of protective strategies that victims use. There are many strategies in addition to leaving the abuser or staying in a shelter. One goal of this review is to broaden the definitions of both what women are trying to protect and how they are trying to protect it. Although many of these protective strategies are already known to advocates and have been previously documented in the research, there is still a disconnect between women's lived realities in comparison with both the public stereotypes about battered women and the types of services offered to support them. It is hoped that this document will be a step towards expanding both perceptions and services.

A Holistic Approach

“…battered women are the strongest women. And nobody will ever change my mind with that. We've had to learn to how to survive” (Melinda, quoted in Davis, 2002, p. 1254).

To fully understand battered women's experiences, a holistic perspective is required. This perspective expands the meaning of “protective strategies,” and raises awareness of the many obstacles that victims confront. Although it is true that there are many more services and legal protections available to victims today than there were 30 or 40 years ago, it is still equally true that most women face substantial constraints in accessing services or using other protective strategies (Davies, Lyon, & Monti-Catania, 1998; Justice & Courage Oversight Panel, 2008). Hamby (2008) organized these constraints into five categories: batterer's behavior, financial obstacles, institutional obstacles, social obstacles, and personal values that complicate women's choices. Batterer's attempts to maintain power and control over their victims manifest themselves in many ways, such as threats to kill the victim if she leaves or attempts to make other changes in their relationship (Pence & Paymar, 1993). Contrary to the widespread assumption that leaving is the best way to increase safety, there is ample evidence that much violence is initiated or worsens after separation as the batterer redoubles efforts to maintain control (Mahoney, 1991; Tjaden & Thoennes, 1998, 2000).

Not all constraints are due to the batterer, however (Davies et al., 1998; Hamby, 2008). There are financial obstacles, such as insufficient funds to rent an apartment or home, lack of health care for oneself or one's children, or the ability to take time off work to address the effects of the abuse. Financial constraints can limit other coping efforts such as seeking counseling. There are also institutional obstacles, such as limited shelter stays that do not allow sufficient time to set up a new home and job, requirements of multiple court appearances for women who do not have access to childcare or transportation, and the dearth of civil attorneys for low-income women. Many services are primarily organized around helping women leave, and if they do not wish to leave they may find few relevant institutional services (Davies, 2008). There are also social obstacles, such as objections by the victim's or perpetrator's families to divorce or terminate the relationship. Members of some cultural groups or communities may experience pressure not to disclose the violence at all. Further, institutional and social obstacles are often exacerbated for certain groups, including immigrant women, elders, youth, pregnant women, lesbian and bisexual women, gay men, transgender people, people of color, women with disabilities, and other groups who may have special needs, complicated legal issues, or other considerations that are not always addressed by standard services.

Finally, personal values, such as beliefs that divorce is wrong, can complicate women's choices as they simultaneously try to remain true to their ideals and protect themselves and their children (Hamby, 2008). The costs of giving up these values can be substantial, both psychologically and socially. For example, if their church or other organization rejects them for breaching its values, a victim might lose considerable social support and even a source of financial and in-kind assistance. Women face dozens of constraints as they strategize about what to do.

Protective Strategies: Understanding What We Know and Don't Know

To the extent that any data on pro-active, protective behaviors are offered at all, the existing research literature has the most to say on strategies women use to protect themselves and their children against physical violence. The lack of research on other strategies battered women use by no means implies they are less frequent or less important —just less studied.

It is important to note, too, that in some cases I have interpreted published data differently than the original authors. Specifically, sometimes behaviors that are interpreted as dysfunctional or passive by the original researchers are considered here to be protective of other goals or needs. For example, choosing not to disclose abuse is often interpreted as denial or some other cognitive distortion. Concealing abuse, or other strategies to dis-identify with victimization, however, can just as easily be seen as impression management strategies that are efforts to minimize the social stigma of being publicly identified as a victim or to minimize the shame that would come to the family for revealing a family secret. Such impression management strategies, or efforts to control others' perceptions of oneself, are common among those with potentially concealable stigmatizing conditions (Goffman, 1963; Herek & Capitanio, 1996).

Oftentimes, researchers describe the strategies most clearly connected to leaving and terminating a relationship as the most protective or best coping strategies. Yet, they typically give little consideration to whether the use of these strategies may actually increase physical risk via separation violence rather than protect women against physical harm (Mahoney, 1991). For example, in the National Violence Against Women Survey (NVAWS), 22% of women victimized by a former spouse reported that the violence occurred after the relationship ended. In fact, in 4% of cases the violence only began after the relationship ended. The pattern for stalking was even more dramatic: 43% of stalking victims were stalked only after terminating a relationship (Tjaden & Thoennes, 1998). Leaving is almost always held up as the gold standard of good coping despite considerable evidence that terminating a relationship is not always a successful strategy for ending abuse.

Finally, the other major limitation of the research on coping and protective strategies is that it usually focuses only on battered women who go to battered women's shelters. In many cases, these are the women with the fewest resources or who are in the worst circumstances. Many women leave abusive, maltreating partners without ever visiting a shelter, speaking with an anti-domestic violence advocate, or disclosing the violence to a civil or criminal court. We know very little about them or their protective strategies. Nonetheless, and despite the limitations of the research, there is substantial evidence that women engage in all kinds of protective strategies and seek many types of help as they attempt to improve their situations, whether they remain in or leave their relationships. The evidence for several specific strategies is presented below.

Specific Protective Strategies

Immediate Situational Strategies

Although much of the literature focuses on long-term protective strategies, a few studies have looked at protective responses in the immediate context of a physical or sexual assault. The first coping responses often occur during or just after an assault. Leaving the house or escaping the scene of the assault was reported by 19% of women in one study (Magen, Conroy, Hess, Panciera, & Simon, 2001). In a randomly drawn community sample, Hamby and Gray-Little (1997) found that immediate self-protective strategies, such as leaving the situation, getting someone's help, or calling the police, were reported by 20% of women. One nationally representative sample found that 16% ran to another room, 8% left the house, and 6% called someone other than the police (Kaufman Kantor & Straus, 1990). Women also try to avoid potentially violent situations: 63% in a study by Yoshihama (2002). Although some authors consider avoidance a passive, poor coping strategy, women's own ratings showed that avoiding violent situations was often an effective protective strategy.

Hitting back is another immediate situational strategy. Although virtually any response can lead to an escalation of the batterer's violence, hitting back may be riskier than most. It may also create legal problems for women, including leading to assault charges against them or damaging their positions in a custody contest. However, some women do choose this strategy: 12% in one nationally representative sample (Kaufman Kantor & Straus, 1990). Although the severity of the violence perpetrated against them and the physical environment can constrain victims' ability to flee or engage in other immediate responses, it is clear that many women respond protectively in the moment that violence occurs.

Protecting Children, Family, Friends, and Pets

Oftentimes, the welfare of others is foremost on a victim's mind. Victims' specific concerns about others are better documented than the specific strategies used to address these concerns. Sometimes protecting others manifests as immediate situational strategies. For example, in one small study of 17 battered women with children, 65% described removing the children from the scene of the violence by moving away from them or putting them in their bedrooms (Haight, Shim, Linn, & Swinford, 2007). Other steps are longer term. Haight et al. (2007) found that almost half of the sample (47%) spoke of reassuring their children and emphasizing to them that the fighting was not the children's fault. Some mothers, ranging from 16% to 24% in two studies, try to teach their children to make nonviolent choices in their own relationships (Haight et al., 2007; Levendosky, Lynch, & Graham-Bermann, 2000).  

The desire to protect others sometimes limits the choice of coping strategies. Across several studies of threats to pets, 26% of women reported that they delayed terminating their relationship because of batterers' threats to kill or harm their companion animals if they left (Hamby, 2008). This is a good example of a situation where no single protective strategy can minimize all risks simultaneously. Although the data available focus on children and pets, it is likely that victims try to protect all loved ones who are threatened.

Using “Classic” Legal and Anti-Domestic Violence Services

Calling the police. Substantial numbers of women call the police in order to obtain protection from their batterer, especially women who are victims of the most severe battering. As with any single strategy, calling the police may have limited effectiveness in preventing future violence and may create other problems. When victims call the police they may expose the batterer to violence from the police, as well as face retaliatory violence from the batterer or the possibility that they themselves may be arrested (Hirschel & Buzawa, 2002; Martin, 1997; Ritchie, 2006). Law enforcement involvement can also be risky for women who may be worried about involvement from child protective services or immigration enforcement.

Studies of women who have had contact with shelters or social services indicate that between 32% and 78% have also called the police (Bui, 2003; Magen et al., 2001; Rounsaville, 1978; Rusbult & Martz, 1995). In the National Crime Victimization Survey, 53% of women reported their intimate partner victimizations to police between 1993 and 1998 (Rennison & Welchans, 2000). In other nationally representative community surveys rates of reporting to the police are lower, most likely because the typical violence reported in such surveys is minor and infrequent. NVAWS found that 21% of female victims contacted the police (Tjaden & Thoennes, 1998). Furthermore, 27% of all victimizations were reported, but not always by the victim (Tjaden & Thoennes, 1998). Although the rates of reporting are lower in community surveys, more severe forms of violence are more likely to be reported to the police. In one survey, Kaufman Kantor and Straus (1990) found that women who sustained severe violence were four times more likely to call the police than women who sustained minor violence (14% vs. 3%). However, not all groups are equally likely to turn to police. For example, using data from Houston, Texas, Bui (2003) estimates that Vietnamese immigrants are five times less likely to call the police than other ethnic groups in Houston. Fears of problems with immigration authorities (whether victims are documented or not) and fears of racial or ethnic discrimination by law enforcement may prevent some victims from contacting police or other authorities (Bui, 2003).

Obtaining a restraining order/order of protection. NVAWS found that 17% of victimized women attained a temporary restraining order. Obtaining a protection order is often more common among women who have engaged in other forms of help-seeking (Dutton, Ammar, Orloff, & Terrell, 2007; Strube & Barbour, 1984). However, numerous problems exist regarding restraining orders that may affect their use by victims. In the NVAWS, for example, 51% of the women who obtained orders said their partner violated their restraining order (Tjaden & Thoennes, 1998). In a sample of immigrant women, 37% felt an order of protection would increase their danger (Dutton et al., 2007). Other problems include lack of legal representation in civil protection order hearings for low-income women and limited enforcement of protection orders in some jurisdictions. Further, despite the full faith and credit provisions of the Violence Against Women Act, which should ensure that orders issued by all states and tribal jurisdictions are respected throughout the country, enforcement of protection orders across jurisdictional lines can be problematic.

Going to a domestic violence shelter . Access to shelters is not as universal as sometimes thought. Fewer than half of U.S. counties have shelters, and those shelters that exist are often full. A national survey on shelter services found that, in a single day, there were more than 4,000 unmet requests for shelter or transitional housing (National Network to End Domestic Violence, 2008). In addition to issues regarding access, some shelters have policies that exclude boys over age 13 (or younger) or exclude women who are actively using drugs or alcohol to cope with the effects of the abuse. Other shelter policies may require residents to participate in interventions, such as parent training. Although such policies are generally meant to protect and assist shelter residents, they effectively exclude many victims in need of shelter. Often operating with very limited resources, shelters may struggle to offer culturally relevant services, particularly to battered women who are the most marginalized, such as immigrants, women of color, women with disabilities, lesbian, gay, bisexual, and transgender survivors of domestic violence, and battered women charged with crimes.

In one nationally representative community survey, 4% of women who left their partner went to a safe house or homeless shelter (author's analysis of archived data from Tjaden & Thoennes, 2000). Another study found that 10% of domestic violence victims sought help from a shelter (Cattaneo & DeLoveh, 2008). A recent study of 3,410 shelter residents in eight states found that, after time in shelter, 92% felt more hopeful about the future, 91% knew more about their options and ways to plan for their safety, and 85% knew more about community resources – outcomes associated with longer-term safety and well-being (Lyon, Lane, & Menard, 2008). Although not used by all victims, emergency shelters serve as an important protective strategy, especially for the most severely abused women and those with the fewest financial and social resources.

Utilizing other domestic violence program services. Although shelter is the service most closely identified with anti-domestic violence programs, most programs offer a variety of services, usually at no cost. Existing data suggests that the most commonly utilized domestic violence-related services include providing information about domestic violence and referrals to other organizations (North Carolina Council for Women, 2007). Indeed, these services are provided more than 10 times as often as shelter. Transportation, court accompaniment, and counseling are also provided more frequently than shelter.

Some racial groups utilize program services more often than others. In North Carolina, which keeps one of the largest databases on domestic violence services, three racial groups comprised larger portions of clients served than they do of the total North Carolina population: African Americans, Hispanics, and American Indians. Two groups were somewhat underrepresented in comparison to their numbers in the population: Whites and Asian Americans. It is possible that racial and ethnic differences in service utilization are due to lower income individuals being overrepresented in some U.S. minority groups. Research demonstrates that lower income women are more likely to use shelters than women with higher income (Cattaneo & DeLoveh, 2008), and may also be more likely to seek help with transportation and other services.

Data suggests that a variety of program services are used by large numbers of victims. However, interpreting service data is complex because some of these services are provided to women while they are in shelter. Shelter “service” can comprise as much as a 90-day stay, while other services take place over much briefer periods of time. Further, not every anti-domestic violence program has the resources to offer shelter, and shelter might be used more if it were more widely available. Finally, as these data come from programs, not victims, one cannot determine what percentage of victims use these various services as part of their coping strategies.

Reaching Out for Social Support

Most women seek social support by disclosing their experiences of abuse to family members, friends, neighbors, and/or co-workers. Social support may provide women with needed validation, another perspective on the situation, support around safety planning, assistance with holding the abusive partner accountable, and a counterbalance to the batterer's minimization, denial, and blame. Social support may also result in tangible offers of help, including places to stay, financial assistance, or places to store belongings in case of emergency. Like most protective strategies, though, seeking social support does entail risks, as women might instead encounter fear, rejection, and stigma.

Despite these risks, most battered women do seek social support. Three studies found the rate of confiding in a friend or family member to be over 90% (Goodkind, Gillum, Bybee, & Sullivan, 2003; Levendosky et al., 2004; Rounsaville, 1978). Another study found that 74% sought help from at least one friend and 47% sought help from family (Yoshihama, 2002). In another study, approximately two-thirds sought support from their own family, while over 40% sought help from friends (Strube & Barbour, 1984). In a sample of Vietnamese immigrants, 62% talked with relatives, friends, or religious leaders (Bui, 2003). Although the total number of people confided in is not often measured, Goodkind et al. (2003) reported that more than half of their sample (56%) talked to both family and friends. Social support can be emotional support and also more direct support. According to one nationally representative survey, 68% of women who leave their partners go stay with family members or friends (author's analysis of archived data from Tjaden & Thoennes, 2000).

Turning to Spiritual and Religious Resources

One of the great disservices to many victims of domestic violence is the frequent categorization of prayer and other spiritual strategies as “passive” or “avoidant” coping. Prayer, and other spiritual ceremonies and resources, may be a great source of strength for women from many cultural and ethnic backgrounds (Hamby & Gray-Little, 2007). Hage (2006) found that faith in God was important to the coping of 90% of the battered women in her sample. Similarly, El-Khoury et al. (2004) found that 88% used prayer to find strength and guidance, and 27% talked to a member of the clergy about their abuse. Spiritual practices are often reported more frequently by women of color, including African American women (El-Khoury et al., 2004) and Muslim women (Hassouneh-Phillips, 2001, 2003). Culturally specific spiritual practices may play an important role in the process of healing and protection, as exemplified by the statement of this American Indian woman from the Seattle area:

…That helped me a lot, … smudging [ritual purifying with the smoke of sacred herbs such as sage] and just doing a lot of different things about being strong and protecting myself, you know. The Native person can teach me how to protect myself in a Native way, like smudging, and not cutting my hair, and just leaving it on the ground so someone can stomp on it! And you know, just things like that, little things. And the music, powwow music was a big healing for my heart and made my heart strong again (Senturia, Sullivan, Cixke, & Shiu-Thorton, 2000, pp. 114-115).

Some women, however, report that their partners use scripture to enhance power and control over them, or that the rules of some organized religions hamper their efforts to protect themselves (Hage, 2006; Hassouneh-Phillips, 2001, 2003). More needs to be done to craft ways of simultaneously supporting women's spirituality and right to safety.

Use of Traditional Health, Mental Health, and Social Services

Fairly large numbers of women seek help from psychologists, social workers, physicians, drug and alcohol abuse treatment providers, community health centers, and other health and social service providers. Some significant impediments to the use of these services exist, including financial costs, concerns about confidentiality, and access to providers with training in domestic violence. Still, they are used fairly frequently. Several studies found the percentage of battered women who sought counseling to be from 9-30% (El-Khoury et al., 2004; Magen et al., 2001; Saunders, 1994). Saunders (1994) also found that 21% of battered women participated in a 12-step program. Another study found that 35% sought the help of a physician or nurse (Magen et al., 2001). Conjoint couples counseling is also sought by some women. Although considered controversial by some, there is emerging evidence that conjoint couples counseling can be safely pursued when minor, noninjurious forms of domestic violence have been perpetrated (O'Leary, Heyman, & Neidig, 1999; Stith, Rosen, McCollum, & Thomsen, 2004). There may be ethnic or cultural differences in the use of these services. For example, one study found European American women were more likely to seek mental health counseling than African American women (El-Khoury et al., 2004). When culturally appropriate, these providers can offer another forum for talking about multiple risks and working out solutions, and can also help address the emotional after-effects of trauma.

Terminating the Relationship

Ending the relationship, by attempting to break up, move out, or divorce, is almost always designed to be a protective strategy. Relationship termination is measured in a number of different ways. Flynn (1990) reported that 37% of her sample ended their relationship in one-month or less following the first episode of violence. Magen et al. (2001) reported that 32% ended the relationship “immediately.” Jacobson, Gottman, Gortner, Berns, and Shortt (1996) followed 45 batterers and their spouses over a two-year period and found that 38% divorced or separated during that time. Griffing et al. (2005) found that 66% separated but later returned to the batterer at least once, demonstrating both how many would like to leave and also the extent of the obstacles many confront in ending the relationship. However, as discussed, it is important to recognize that leaving can entail significant risks, especially to women with the most aggressive or emotionally unstable partners. These risks may include homicide, separation violence, and loss of custody of children.

Invisible Strategies

The following list of invisible strategies may seem like a pretty long list of protective strategies, and in some respects it is—more than a dozen specific strategies have been studied. Yet what is also striking about the research on protective strategies is what is missing, particularly from quantitative research on victims of domestic violence. For example, there is virtually no quantitative research on a wide range of strategies, including how many women:

open bank accounts and start saving money, which is probably one of the most important strategies for increasing the number of viable options a victim can pursue, ranging from filing for divorce to contesting custody to securing living arrangements.

  • return to school to increase their job skills and gain all of the other benefits of an education.
  • file for custody of their children, or seek supervised visits for their children when they visit their father.
  • relocate to get away from a stalker.
  • coach their children on how to escape during a violent episode or take steps to minimize their children's time with the batterer.
  • successfully work with their partners, with or without the assistance of advocates or therapists, to make their relationship safe.
  • examine all of their constraints and options and make a calculated decision that staying is the safest thing to do at that moment.

Advocates and others who work regularly with battered women know that women take all of these actions. Indeed, advocates help women with many of them. However, while there are some references to these actions in qualitative interviews of victims, we know very little about how common they are.

Another feature of victim's coping that is often invisible is the shear number of different strategies that victims try. Hamby and Gray-Little (1997) found in their community sample that the average number of protective strategies increased as the level of violence progressed from minor to more severe. We need to learn much more about how many different ways victims typically try to address the problem of violence and other forms of abuse.

Different Approaches to Protection

The above examples illustrate the wide array of choices available to victims trying to protect themselves and their loved ones. Hamby and Gray-Little (2007) have proposed a model for understanding different ways of coping with the problems created by battering. It represents a continuum of approaches that victims might adopt, and how these approaches can involve multiple strategies, not just leaving the relationship. It is based on a model from the world of finance. One of the key advantages offered by this financial model is that the full range of coping strategies are de-stigmatized—no one strategy is automatically deemed superior for every person. This provides a concrete analogy for how we might reframe our perceptions of victim's coping strategies.

The Conservative Strategy

In finance, a conservative strategy is one that emphasizes low-risk investments, often promising guaranteed returns, such as savings accounts or certificates of deposit. The conservative strategy minimizes or even virtually eliminates the risk of loss. In exchange for this low risk, however, investors accept a relatively low rate of return on their investments.

The conservative strategy is a better descriptor for strategies used by many women who might otherwise be labeled passive. People who take a conservative approach to coping tend to focus on minimizing the risk of further losses in many areas. Examples of such risks are the loss of financial well-being, housing, or custody of their children. They also may be trying to reduce the risk of separation violence, stalking, or harm to animals if they try more active coping strategies. Thus, conservative “copers” may be more likely to choose ways of addressing the violence, such as discussing it with their partners or seeking counseling, which do not involve leaving the relationship or making other large changes in their situation.

Conservative copers may also try to minimize the risk of stigma by using information management. Although this may appear to be minimization or denial, there is an enormous difference between a conscious effort to avoid stigma and a cognitive distortion. Terms like “minimization” and “denial” suggest that the woman herself does not fully recognize her own victimization, which Hamby and Gray-Little (1997) have found to be rare.

In the financial world, personal characteristics, such as low net worth, are associated with a greater tendency to use a conservative strategy (Embrey & Fox, 1997). Such findings provide another parallel to the situation of battered women, who may be seen as passive copers but only when others fail to consider their context, such as a lack of financial resources. Leaving takes considerable economic and social resources. Thousands of dollars are required, for example, to secure and furnish a new home and file for divorce. Likewise, it is difficult to make major life changes without social support. Women without these resources may adopt a conservative strategy because they don't have the resources to choose other strategies, or because they stand to lose the few resources they do possess if their strategies do not work as planned.

The Venture Strategy

At the other end of the continuum is the “venture” strategy. In the investing world, this strategy is frequently referred to as an “aggressive” strategy, but we have avoided this term because we do not want to imply that women's use of violence is the only, or even a necessary, element of this approach. The term “venture” is designed to capture the higher element of risk that is the central component of this strategy. Confronting the perpetrator and leaving, especially in the midst of a crisis, are examples of what are, statistically, high-risk strategies (Davies, 2009). Some of these risks pertain directly to increased risks of further violence and stalking following separation, both of which are well documented (e.g., Tjaden & Thoennes, 1998). Leaving is also associated with threats by the batterer to harm children, pets, and victims' family members (Hamby, 2008). Some victims face other significant and even life-threatening risks, such as the risk of deportation for some immigrants (Hamby, 2008). Because many battered women face a daunting array of such risks, an over-emphasis on venture strategies may be dangerous, but this depends on individual circumstances.

The Balanced Strategy

Many financial advisors recommend a strategy between these two extremes—a balanced strategy. In finance, a balanced strategy refers to the creation of a diversified portfolio of investments that represent varying degrees of risk. The recommended balance of low- and high-risk investments varies with an individual's personal situation. A young person, or someone with a lot of money, can afford to take greater risks than people approaching retirement age with modest assets. The balanced strategy probably characterizes most women who have been battered. The few studies that assess many types of responses to violence (Hamby & Gray-Little, 1997; Yoshihama, 2002) indicate that many women—perhaps two-thirds—are trying numerous responses to violence, including some that are typically labeled “active” and “passive.” Instead of trying to characterize victim's coping as either active or passive, it would be better to recognize that a smart overall strategy might include elements of both. That is likely to be the best way to simultaneously minimize harms and maximize the potential for gains.


A lot of people look at the efforts of battered women and see a glass half empty—too few efforts, executed too late after the violence begins. The data, however, better support the view that most women are making many efforts to protect themselves and their children, and improve their situation, whether they remain in or leave their relationships. Not surprisingly, seeking social support is far and away the most common strategy and reported by the vast majority of respondents who are given the chance to describe active strategies. It makes sense that talking over the problem with someone else would be the first step towards deciding what other actions to take.

It likewise makes sense that battered women may vary in their approach to protective strategies. For example, a woman with good financial resources is probably more likely to move directly into another home or apartment, rather than staying in a shelter. The typical battered woman is constantly assessing her risk of danger and trying different protective strategies in response. As they see how different strategies work under varying conditions, they continue to strategize and adapt. We need to know much more than we do about when and why women choose particular strategies, and much more about all of the various strategies that women do use. A balanced overall strategy that operates on several fronts—not just focusing on safety but also acknowledging all of the risks that women face—is almost certainly what most women do. In order to best help battered women maximize gains and minimize losses across all the domains of their lives, advocates, providers, and scholars all need to work harder to step back and see the full world in which the victim lives.

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Emerging Responses to Children Exposed to Domestic Violence

Jeffrey L. Edleson

In consultation with Barbara A. Nissley

Public attention to the effects of children’s exposure to adult domestic violence has increased over the last decade. This attention focuses on both the impact of the exposure on children’s development and on the likelihood that exposed children may be at greater risk for becoming either a child victim of physical or sexual abuse or an adult perpetrator of domestic violence. New research, policies, and programs focused on these children have resulted. These new efforts are reviewed in this document and an argument is made that the diversity of children’s experiences requires equally diverse responses from our communities.

Definitions of Domestic Violence and Exposure

Jouriles, McDonald, Norwood, and Ezell (2001) suggest that a number of issues affect how we define exposure to adult domestic violence. First, the types of domestic violence to which children are exposed may be defined narrowly as only physically violent incidents or more broadly as including additional forms of abuse such as verbal and emotional. Second, even within the narrower band of physical violence, there is controversy about whether we should define adult domestic violence as only severe acts of violence such as beatings, a broader group of behaviors such as slaps and shoves and psychological maltreatment, or a pattern of physically abusive acts (see Osthoff, 2002). Finally, despite documented differences in the nature of male-to-female and female-to-male domestic violence, should one and not the other be included in a definition when considering children’s exposure to such events?

Settling on the definition of domestic violence does not settle still other definitional questions that arise. For example, how is exposure itself defined? Is it only direct visual observation of the incident? Should our definitions also include hearing the incident, experiencing the events prior to and after the event or other aspects of exposure?

Throughout this paper the phrase “exposure to adult domestic violence” will be used to describe the multiple experiences of children living in homes where an adult is using physically violent behavior in a pattern of coercion against an intimate partner. Domestic violence may be committed by same-sex partners as well as by women against men. However, the available research on child exposure almost exclusively focuses on homes where a man is committing domestic violence against an adult woman, who is most often the child’s mother. Thus, unless otherwise identified, the studies reviewed here focus on heterosexual relationships in which the male is the perpetrator of violence.

The Impact of Exposure on Children

Carlson (2000) has conservatively estimated that from 10% to 20% of American children are exposed to adult domestic violence every year. Her estimate is based on a review of surveys of adults recalling their exposures as children and of teens reporting current exposures. Whatever the true number of exposed children, it is likely to be in the many millions each year. National surveys in this country and others also indicate that it is highly likely that the severity, frequency, and chronicity of violence each child experiences vary greatly.

Recent meta-analyses -- statistical analyses that synthesize and average effects across studies -- have shown that children exposed to domestic violence exhibit significantly more problems than children not so exposed (Kitzmann, Gaylord, Holt & Kenny, 2003; Wolfe, Crooks, Lee, McIntyre-Smith & Jaffe, 2003). We have the most information on behavioral and emotional functioning of children exposed to domestic violence. Generally, studies using the Child Behavior Checklist (CBCL; Achenbach & Edelbrock, 1983) and similar measures have found children exposed to domestic violence, when compared to non-exposed children, exhibit more aggressive and antisocial (often called “externalized” behaviors) as well as fearful and inhibited behaviors (“internalized” behaviors), show lower social competence and have poorer academic performance. Kitzmann et al. (2003) also found that exposed children scored similarly on emotional health measures to children who were physically abused or who were both physically abused and exposed to adult domestic violence.

Another all too likely effect is a child’s own increased use of violence. Social learning theory would suggest that children who are exposed to violence may also learn to use it. Several researchers have examined this link between exposure to violence and subsequent use of violence. For example, Singer et al. (1998) studied 2,245 children and teenagers and found that recent exposure to violence in the home was significantly associated with a child’s violent behavior in the community. Jaffe, Wilson, and Wolfe (1986) have also suggested that children’s exposure to adult domestic violence may generate attitudes justifying their own use of violence. Spaccarelli, Coatsworth, and Bowden’s (1995) findings support this association by showing that adolescent boys incarcerated for violent crimes who had been exposed to family violence believed more than others that “acting aggressively enhances one’s reputation or self-image” (p. 173). Believing that aggression would enhance one’s self-image significantly predicted violent offending.

A few studies have examined longer-term problems reported retrospectively by adults or indicated in archival records. For example, Silvern et al.’s (1995) study of 550 undergraduate students found that exposure to domestic violence as a child was associated with adult reports of depression, trauma-related symptoms, and low self-esteem among women and trauma-related symptoms alone among men. They found that after accounting for the effects of being abused as a child, adult reports of their childhood exposure to domestic violence still accounted for a significant degree of their problems as adults. Exposure to domestic violence also appeared to be independent of the impacts of parental alcohol abuse and divorce. In the same vein, Henning et al. (1996) found that 123 adult women who had been exposed to domestic violence as a children showed greater distress and lower social adjustment when compared to 494 non-exposed adult women. These findings remained even after accounting for the effects of witnessing parental verbal conflict, being abused as a child, and varying degrees of parental caring.

Children’s Involvement in Violent Incidents

Studies have found that children respond in a variety of ways to violent conflict between their parents. Children’s involvement in violent situations has been shown to vary from their becoming actively involved in the conflict, to distracting themselves and their parents, or to distancing themselves by leaving the room (Garcia O’Hearn, Margolin, & John, 1997; Peled, 1998). Children in homes in which violence has occurred were nine times more likely to verbally or physically intervene in parental conflicts than comparison children from homes in which no violence occurred (Adamson & Thompson, 1998). Edleson et al. (2003) found that 40 of 111 battered mothers (36%) reported their children frequently or very frequently yelled to stop violent conflicts; 13 (11.7%) of the mothers reported that their children frequently or very frequently called someone for help during a violent event; and 12 (10.8%) reported their children frequently or very frequently physically intervened to stop the violence.

More often young children appear to be present during domestic violence incidents than older children. Examining data on police and victim reports of domestic assault incidents, Fantuzzo and colleagues (Fantuzzo, et al., 1997) found that in all five cities studied, children ages 0 to 5 years were significantly more likely to be present during single and recurring domestic violence incidents. Children’s responses to violent events appear to also vary with age (Cummings, Pellegrini, Notarius, & Cummings, 1989). In one early study, even children ages one to two and a half years responded to angry conflict that included physical attacks with negative emotions and efforts to become actively involved in the conflicts (Cummings, Zahn-Waxler, & Radke-Yarrow, 1981).

These findings have led many to conclude that every child exposed to domestic violence is significantly harmed by the experience. Yet, as the section below will show, many children appear to survive such exposure and show no greater problems than non-exposed children.

Protective Factors in Children’s Lives

Most would be convinced by the afore mentioned studies that children exposed to adult domestic violence would all show evidence of greater problems than non-exposed children. In fact, the picture is not so clear. There is a growing research literature on children’s resilience in the face of traumatic events (see, for example, Garmezy, 1974; Werner & Smith, 1992; Garmezy & Masten, 1994). The surprise in these research findings is that many children exposed to traumatic events show no greater problems than non-exposed peers, leading Masten (2001) to label such widespread resilience as “ordinary magic”.

The studies of exposed children reviewed earlier compared groups of children who were either exposed or not exposed to adult domestic violence. The results reported were based on group trends and may or may not indicate an individual child’s experience. Graham-Bermann (2001) points out that, consistent with the general trauma literature, many children exposed to domestic violence show no greater problems than children not so exposed. Several studies support this claim. For example, a study of 58 children living in a shelter and recently exposed to domestic violence found great variability in problem symptoms (Hughes & Luke, 1998). Over half the children in the study were classified as either “doing well” (n=15) or “hanging in there” (n=21). Children “hanging in there” were found to exhibit average levels of problems and self-esteem and some mild anxiety symptoms. The remaining children in the study did show more severe problems: nine showed “high behavior problems”, another nine “high general distress” and four were labeled “depressed kids”. In another study, Grych et al. (2000) found that of 228 shelter resident children studied, 71 exhibited no problems, another 41 showed only mild distress symptoms, 47 exhibited externalized problems, and 70 were classified as multi-problem.

How does one explain these great variations among exposed children? Both of the above studies were based on children living in battered women’s shelters. On the one hand, these children may have been exposed to more severe violence than a community-resident sample of exposed children. On the other hand, shelter-resident children may also have greater protective social supports available to them when studied. There are also likely a number of protective assets and risk factors that affect the degree to which each child is influenced by violence exposures.

The resilience literature suggests that as assets in a child’s environment increase, the problems he or she experiences may actually decrease (Masten & Reed, 2002). Protective adults, including the child’s mother, relatives, neighbors and teachers, older siblings, and friends may all play protective roles in a child’s life. The child’s larger social environment may also play a protective role if extended family members or members of church, sports or social clubs with which the child is affiliated act to support or aid the child during stressful periods. Harm that children experience may also be moderated by how a child interprets or copes with the violence (see Hughes, Graham-Bermann & Gruber, 2001). Sternberg et al. (1993) suggest that “perhaps the experience of observing spouse abuse affects children by a less direct route than physical abuse, with cognitive mechanisms playing a greater role in shaping the effects of observing violence” (p. 50).

Children also experience differing levels of other risk factors, as the following section will reveal.

Risk Factors in Children’s Lives

One risk factor that leads to variation in children’s experiences is the great variation in severity, frequency, and chronicity of violence. Research has clearly documented the great variation of violence across families (see Straus & Gelles, 1990). It is likely that every child will be exposed to different levels of violence over time. Even siblings in the same household may be exposed to differing degrees of violence depending on how much time they spend at home. Increases in violence exposure may pose greater risks for children while decreases may lessen these risks.

A number of additional factors seem to play a role in children’s exposure and interact with each other creating unique outcomes for different children. For example, many children exposed to domestic violence are also exposed to other adverse experiences. In a study of 17,421 patients within a large health maintenance organization, Felitti, Anda and their colleagues (Dube, Anda, Felitti, Edwards, & Williamson, 2002) found that increasing exposure to adult domestic violence in a child’s life was associated with increasing levels of other “adverse childhood experiences” such as exposure to substance abuse, mental illness, incarcerated family members and other forms of abuse or neglect. This finding points to the complexity of exposed children’s lives. For example, many exposed children are also direct victims of child abuse (Appel & Holden, 1998; Edleson, 1999; Hughes, Parkinson, & Vargo, 1989; McClosky, Figueredo, & Koss, 1995). Again, in a study of adverse childhood experiences, Felitti, Anda and their colleagues (Whitfield, Anda, Dube, & Felitti, 2003) found that among the 8,629 HMO patients studied, men exposed to physical abuse, sexual abuse, and adult domestic violence as children were 3.8 times more likely than other men to have perpetrated domestic violence as adults.

Problems associated with exposure have been found to vary based on the gender and age of a child but not based on his or her race or ethnicity (Carlson, 1991; Hughes, 1988; O’Keefe, 1994; Spaccarelli et al., 1994; Stagg, Wills, & Howell, 1989). The longer the period of time since exposure to a violent event also appears to be associated with lessening problems (Wolfe, Zak, Wilson, & Jaffe; 1986).

Finally, parenting has also been identified as a key factor affecting how a child experiences exposure. More data are available on battered mothers and their caregiving than on perpetrators and theirs. Unfortunately, at times the over reliance on data collected from and about battered mothers may lead to partial or inaccurate conclusions. For example, it may be that the perpetrator’s behavior is the key to predicting the emotional health of a child. By not collecting data about the perpetrators, we may incorrectly conclude it is the mothers’ problems and not the perpetrators’ violent behavior that is creating negative outcomes for the children.

Given this imbalance in the research, the available studies reveal that battered mothers appear to experience significantly greater levels of stress than nonbattered mothers (Holden & Ritchie, 1991; Holden et al., 1998; Levendosky & Graham-Bermann, 1998) but this stress does not always translate into diminished parenting. For example, Levendosky et al. (2003) found that among the 103 battered mothers they studied many were “compensating for the violence by becoming more effective parents” (p. 275).

What little research there is on violent men shows that they have a direct impact on the parenting of mothers. For example, Holden et al. (1998) found that battered mothers, when compared to other mothers, more often altered their parenting practices in the presence of the abusive male. Mothers reported that this change in parenting was made to minimize the men’s irritability. A survey of 95 battered mothers living in the community (Levendosky, Lynch, & Graham-Bermann, 2000) indicated that their abusive partners undermined the mothers’ authority with their children, making effective parenting more difficult. In an earlier qualitative study of one child support and education group program, Peled and Edleson (1995) found that fathers often pressured their children not to attend counseling when mothers were seeking help for their children. Finally, the relationship between the child and the adult perpetrator appears to influence how the child is affected by exposure. A recent study of 80 mothers residing in shelters, and 80 of their children revealed that an abusive male’s relationship to a child directly affects the child’s well-being, without being mediated by the mother’s level of mental health (Sullivan et al., 2000). Violence perpetrated by a biological father or stepfather was found to have a greater impact on a child than the violence of nonfather figures, such as partners or ex-partners of the mother who played a minimal role in the child’s life.

Public Policy Responses

Laws relating to child exposure to domestic violence have changed considerably in the last decade. These laws focus most often on criminal prosecution of violent assaults, custody and visitation decision-making, and the child welfare system’s response (Lemon, 1999; Mathews, 1999; Weithorn, 2001).

Criminal prosecution of violent assaults
There are several examples of recent legislative changes in criminal statutes that directly respond to concerns about the presence of children during domestic violence assaults (see Dunford-Jackson, 2004; Weithorn, 2001). In a number of states, laws have been changed to permit misdemeanor level domestic assaults to be raised to a felony level charge. In Oregon, a domestic violence assailant can now be charged with a felony assault if a minor was present during the assault. “Presence” is defined in Oregon as in the immediate presence of or witnessed by the child. Another example of changes in criminal prosecution is legislation in at least 18 states that allows more severe sanctions to be imposed on a convicted domestic violence assailant when minors are present during the attack. Assaults committed in the presence of a minor are considered as only one factor that may influence the sanctions imposed in most of the states. Finally, Utah and at least two other states have taken a different approach by defining the presence of a minor during a domestic violence assault as cause for a separate misdemeanor charge.

On the one hand these new laws are likely to increase the attention of the police, prosecutors, and courts when children are present during domestic violence incidents. Greater sanctions are likely to be imposed when it is perceived that there is more than one victim of the adult domestic assault, namely the children. On the other hand there is concern about these changes on a number of levels (Dunford-Jackson, 2004). First, given the increasingly scarce resources of police agencies and prosecutors’ offices, there is concern that attention will focus primarily on cases where children are present because of the likelihood that this factor will increase convictions or guilty pleas. One resulting fear is that children will be brought into court more often to testify in such cases. Another fear is that battered women without children will receive less attention to their cases because police and prosecutors will see them as weaker cases. Finally, many argue that if current criminal statutes were enforced more consistently there would not be a need for these additional laws focused on children. Finally, a particular concern about Utah’s legislation is that it may be used against battered mothers for “failing to protect” their children from an assailant.

There is little research on the impact of these criminal statute changes. In one of the few studies of these laws, Whitcomb (2000) surveyed 128 prosecutors in 93 jurisdictions across the U.S. by telephone regarding their work with children exposed to violence and the impact of new laws regarding them. She also conducted face-to-face interviews in five jurisdictions to shed more light on the telephone surveys. She found that: (1) none of the jurisdictions had protocols governing the prosecution of domestic violence and child maltreatment in the same families; (2) prosecutors in jurisdictions in which laws were in place regarding children’s exposure to domestic violence were more likely to report domestic violence cases to child protection agencies, but no more likely to prosecute mothers for “failure to protect;” (3) prosecutors were seeking enhanced penalties in domestic violence cases when children were also present, even in jurisdictions where no new laws regarding children exposed to domestic violence were in place; and (4) 75% of the prosecutors interviewed said they would not report or prosecute a mother for failing to protect her children from exposure to her own victimization, and the remaining prosecutors said they would only do so when there were additional factors indicating extreme danger to the child. Whitcomb’s research is clearly a starting point, but a great deal more research is needed on these law changes and both their intended and unintended consequences for battered mothers and their children.

Custody and visitation disputes
Most states now include the “presence of domestic violence” as a criterion that judges may use to determine custody and visitation arrangements when disputed. In most jurisdictions, here and in other Western countries, there has been an assumption that both parents have the right and ability to share custody and visitation of their children (Eriksson & Hester, 2001). In approximately about two dozen states, however, this presumption has been reversed in what are commonly referred to as “rebuttable presumption” statutes. Rebuttable presumption statutes generally state that when domestic violence is present it is against the best interests of the child for the documented perpetrator to be awarded custody until his or her safety with the child is assured. California Family Code is an example of a rebuttable presumption statute. Under § 3044 “there is a rebuttable presumption that an award of sole or joint physical or legal custody of a child to a person who has perpetrated domestic violence is detrimental to the best interest of the child.” California’s code outlines six factors to consider in assessing whether a perpetrator of domestic violence has overcome this presumption, including no new violence or violations of existing orders and successful completion of assigned services such as batterer intervention and substance abuse programs.

One difficulty in applying rebuttable presumption statutes is defining what evidence of domestic violence will be admitted as part of the custody and visitation decision-making process. Is it a past or present arrest or restraining order? Should it be a prior conviction or guilty plea? In a rebuttable presumption statute passed by the State of Wisconsin’s Legislature and signed into law in February of 2004, guardians ad litem are given the responsibility for investigating all accusations of domestic violence and reporting their conclusions to the judge. The new law instructs judges to make domestic violence their top priority by stating that “if the courts find…that a parent has engaged in a pattern or serious incident of interspousal battery [as described in statutes], or domestic abuse, the safety and well-being of the child and the safety of the parent who was the victim of the battery or abuse shall be the paramount concerns in determining legal custody and periods of physical placement” (Wisconsin Act 130, §25, 767.24(5)). The new law also requires training of all guardians ad litem and custody mediators in assessing domestic violence and its impact on adult victims and children and lays out new procedures for safe mediation.

While legislative developments such as rebuttable presumption laws appear to be positive, there is little or no evaluation of their impact on children’s and non-abusive parents’ safety. There also are a number of other critical issues that remain mostly unattended in custody and visitation decisions that involve domestic violence. Part of the problem is that many battered mothers are self-represented in disputed custody cases. This raises concerns about both safety for the adult victims and the degree to which they are well represented in court proceedings.

Poor representation for adult victims, or even raising the issue of domestic violence in court proceedings, may compound in a number of ways with other outcomes that can disadvantage her, for example: (1) the abuser or his legal counsel accusing the mother of purposefully alienating her children from him using empirically questionable concepts such as Parental Alienation Syndrome (Faller, 1998); (2) using “friendly parent” provisions of custody statutes to accuse a mother concerned about her and her children’s safety of being uncooperative; (3) minimizing the impact of adult domestic violence exposure on children’s safety and well-being; (4) inappropriately using standardized psychological tests that have not been developed to assess domestic violence to question the veracity of battered women’s testimony or her parenting abilities; and (5) appointing custody evaluators or mediators, guardians ad litem, and court appointed special advocates (CASAs) who have little training on issues of domestic violence to assess families and advise the court on custody and visitation arrangements. These issues may further disadvantage battered mothers who are not represented by an attorney and in cases where the abuser persistently uses court actions to extend his control or harassment of her.

Again, as with changes in criminal statutes, there is little research on these law changes in the domain of custody and visitation. Kernic et al. (2005) studied 324 divorcing couples with a documented history of domestic violence to 532 divorcing couples with no such history. They found that even if domestic violence is a criterion for deciding on custody and visitation, it does not seem to change court outcomes. Court records failed to identify documented domestic violence in almost half of the cases, and in approximately another quarter allegations were noted but not documented despite available evidence. Battered mothers were no more likely than others to be awarded custody of their children and violent fathers were seldom denied visitation. In another recent study, Morrill et al. (2005) reviewed 393 custody and visitation orders involving domestic violence across six states and surveyed 60 judges. They found that in most jurisdictions when a rebuttable presumption was in place, that battered mothers more often received custody and violent fathers were more often given scheduled and restricted visitation with their children. This was true except in jurisdictions where “friendly parent” and/or presumptions of joint custody were also in place creating a contradictory legal environment.

Child welfare regulations
Finally, some states have approached child exposure by expanding the definitions of child maltreatment to include children who have been exposed to domestic violence. For example, in 1999, the Minnesota State Legislature expanded the definition of child neglect in the Maltreatment of Minors Reporting Act to include exposure to adult domestic violence as a specific type of neglect (Minn. State Ann. §626.556, see Minnesota Department of Human Services, 1999; see Edleson, Gassman-Pines, & Hill, 2006). The change in Minnesota acknowledged what had long been believed to be the practice in many child protection agencies across the country - accepting certain reports of children’s exposure to adult domestic violence as child neglect.

This change in Minnesota’s definition of child neglect to include children exposed to domestic violence meant that the state was suddenly mandating that a range of professionals report every child they suspected had witnessed adult domestic violence. A survey of 52 Minnesota counties estimated that the language change would generate 9,101 new domestic violence exposure reports to be screened by child protection agencies each year (Minnesota Association of County Social Service Administrators, 2000), a greater than 50% increase over current levels. While exact figures are not available, the change in definition resulted in rapidly rising child maltreatment reports across Minnesota. This relatively simple change resulted in dramatically increasing workloads in most Minnesota county child protection agencies. Though legislators thought the language change would merely clarify existing practices, many county agencies suddenly faced huge numbers of newly defined neglected children being reported to them.

The increase in child maltreatment reports created significant problems for many county agencies. There were two parts to this change that raised particular concerns among county social service administrators. First, current Minnesota law required an immediate response to all child maltreatment reports. Second, there was no specific funding appropriated to implement this change. Social service administrators argued that the change represented an “unfunded mandate” by the Legislature. Child protection workers already felt their agencies were inadequately supported and the large increase of reports threatened to stretch some counties beyond their capacity to respond. As current and former child protection workers explained, there was a wide range of children that were swept up by the legislation, some of whom were very much in need of child protective services, and others who needed services but not those of child protection.

The expanded reporting requirements also raised concerns among advocates for battered women who feared that as a result of the new definition child protective services would utilize methods that would blame more mothers for their male partners’ violent behavior toward her by finding her case as substantiated for “failure to protect” (see Magen, 1999). This very issue was the focus of a recent class action lawsuit against the City of New York’s child protection agency. The court found that the City had unconstitutionally removed children from the custody of their non-abusive battered mothers after substantiating mothers for engaging in domestic violence. Engaging in domestic violence often simply meant being a victim at the hands of an adult male perpetrator (Nicholson v. Williams).

Minnesota’s story really had two endings, both of which were frustrating and raise questions about an appropriate response to these families. In the first ending, the community responded to the expanded definition of neglect by reporting many thousands of newly identified Minnesota children exposed to domestic violence. Unfortunately, the capacity of child protective services to respond was greatly strained, resulting in more identification and screening but probably fewer services to those most in need. In the second ending, almost all Minnesota counties decided to drop the requirement for reporting exposed children to child protective services after the Legislature repealed the change. The sad outcome of this result is that many thousands of children who were earlier identified were no longer visible in the systems and also not likely to receive needed services (see Edleson, Gassman-Pines, & Hill, 2006, for a more completed discussion of Minnesota’s experience).

Many communities around the country have attempted to change the way they respond to battered women and their children as a reaction to experiences similar to those outlined throughout this section. Below, some of the more noteworthy responses are reviewed.

Implications for Practice Responses

The implications of these research findings and some of the states’ experiences with legislation suggest several key points:

  • Children’s social environments and experiences vary greatly;
  • The impact of exposure also varies greatly, even within the same families;
  • Children have a variety of protective and risk factors present in their lives; and
  • This varied group of children deserves a varied response from our communities

It is clear from the available research that children exposed to adult domestic violence are not a monolithic group. The frequency, severity, and chronicity of violence in their families, their own level of exposure to this violence, children’s own ability to cope with stressful situations, and the multiple protective factors present (e.g. a protective battered mother) as well as the multiple risks present (e.g. substance abuse or mental illness among caregivers) create a group of children who are as varied as their numbers. These many factors combine in unique ways for each child, likely creating unique impacts as a result of exposure.

Child exposure should not be automatically considered child maltreatment under the law and our current responses may not match the needs of families precisely because there are such varied impacts among children. Certainly many children will be referred to child protection agencies because of direct attacks on them. Given the limited resources of most public child welfare agencies, families and their children who show minimum evidence of harm resulting from such exposure and who have other protective factors present in their lives may benefit more from voluntary services in the non-profit sector.

Many of these children will enter our child protection systems because they are abused children and in disproportionate numbers based on race and class. Child protection systems must re-examine their responses to families in which both children and adults are being abused. Every effort must be made to keep children with their non-abusing caregivers, provide safety resources for both adult and child victims in a family, and develop new methods for intervening with men who both batter their adult partners and the children in their homes. Federal and privately funded efforts are underway to test new ways of collaborative work between child protection systems, the courts, and domestic violence organizations (see http://www.thegreenbook.info). Alternative or differential response initiatives within child protection systems may, in part, provide an additional avenue for providing more voluntary services to the lower risk cases (Sawyer & Lohrbach, 2005).

Perhaps the greater challenge is to develop voluntary systems of care for children who are exposed to domestic violence but not themselves direct victims of physical abuse. These systems of care often operate outside of child protection agencies and allow communities to rely on more than one type of response, thereby avoiding overwhelming the child protection system. Such responses include expanded programming within domestic violence organizations, partnerships with community-based organizations, and new types of “child witness to violence” projects around the country (see Drotar et al., 2003). Many of these programs stress the importance of mothers in their children’s healing and encourage mother-child dyadic interventions (see Groves, Roberts, & Weinreb, 2000; Lieberman, Van Horn, & Ippen, 2005). These systems of care need to be developed as part of the fabric of communities from which the women and children come if they are to be sustained and culturally proficient.

Beyond treatment, there is a dire need to begin efforts that engage community members in taking part in community wide prevention. Developing the capacity of formal and informal systems to understand the social roots of domestic violence, to promote batterer accountability, and to better respond to cultural differences are all important benefits that may be derived from community engagement. Greater community engagement and system coordination also offer the possibility of overcoming institutional barriers that commonly stand in the way of creating safety for battered mothers and their children.

Communities across North America are significantly revising the way they think about children exposed to domestic violence. At local, county and state levels, communities are engaged in a variety of policy and programmatic actions to respond to these children and their families. The recently reauthorized federal Violence Against Women Act of 2005 for the first time addresses the needs of these children. We need to continue to develop multiple pathways into services and multiple responses by social institutions if we are to adequately address the needs of these children and help them to grow into emotionally and physically healthy adults.

Author of this document:
Jeffrey L. Edleson, Ph.D.
Director, Minnesota Center Against Violence & Abuse
Professor, School of Social Work
University of Minnesota

Barbara A. Nissley, M.H.S.
Children's Program Specialist
Pennsylvania Coalition Against Domestic Violence


Citation: Edleson, J.L. (2006, October). Emerging Responses to Children Exposed to Domestic Violence. Harrisburg, PA: VAWnet, a project of the National Resource Center on Domestic Violence/Pennsylvania Coalition Against Domestic Violence. Retrieved month/day/year, from: http://www.vawnet.org


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Substance Abuse and Intimate Partner Violence

Larry Bennett and Patricia Bland

Substance abuse (SA) and intimate partner violence (IPV) are closely associated in the public mind. Many people believe that men's abuse of drugs or alcohol is a primary reason for their battering. Others think that SA may increase the risk for IPV, but is not a direct cause of IPV. Still others believe SA and IPV are separate issues, which only appear to be related due to other factors. In fact, both SA and IPV have many causes and many effects, and their apparent correlation applies to only a sub-group of batterers and victims (Testa, 2004). For some men who batter, SA may increase the frequency or severity of their violence. For other men, SA and IPV are separate issues whose apparently high rate of co-occurrence may stem from shared pre-conditions such as antisocial personality (Fals-Stewart, Leonard & Birchler, 2005) or from a belief that when they get drunk or high, they are going to be violent (Field, Caetano, & Nelson, 2004). Finally, for some men, both substance abuse and IPV may be manifestations of an underlying need for power and control related to gender-based distortions and insecurities (Gondolf, 1995). CEU

Regardless of the explanation for it, the co-occurrence of IPV and SA is substantial across a series of studies:

  • Half of the men in batterer intervention programs appear to have SA issues (Gondolf, 1999) and are eight times as likely to batter on a day in which they have been drinking (Fals-Stewart, 2003).
  • Approximately half of partnered men entering substance abuse treatment have battered in the past year (Chermack, Fuller & Blow, 2000; Fals-Stewart & Kennedy, 2005) and are 11 times as likely to batter on a day in which they have been drinking (Fals-Stewart, 2003).
  • Between a quarter and half of the women receiving victim services for IPV have SA problems (Bennett & Lawson, 1994; Downs, 2001; Ogle & Baer, 2003).
  • Between 55 and 99 percent of women who have SA issues have been victimized at some point in their life (Moses, et al., 2003) and between 67 and 80 percent of women in SA treatment are IPV victims (Cohen, et al., 2003; Downs, 2001).

For all the reasons above, SA issues should always be considered when making decisions about the safety of IPV victims and the risk posed by IPV perpetrators. Likewise, past and current IPV, along with other trauma-related issues, should always be considered when assisting men and women recovering from the effects of SA. In the remainder of this paper, we will discuss the co-occurrence of SA and IPV, highlight the special role of men's drunkenness in IPV, examine substance abuse by victims, and briefly present issues related to coordination and integration of SA and IPV services.

In this paper, except when a special distinction is necessary, we will use the term SA (substance abuse) to refer to both the continued use of or dependency on alcohol or other drugs in the face of adverse consequences. We will use the term IPV (intimate partner violence) to refer to threatening or controlling behavior, both physical and non-physical, directed at women by men who are their partners or ex-partners. While IPV also includes violence in gay and lesbian relationships, and violence to men by their women partners, very little information exists on the link between SA and these other forms of IPV. In this paper we will limit IPV to threatening or controlling behavior, both physical and non-physical, directed at women by men who are their partners or ex-partners.




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Child Welfare Information Gateway, Spousal Partner Abuse CEUs

Leslie Tutty; Husband Abuse:An Overview of Research and Perspectives Family Violence Prevention Prevention Unit, Canada, 1999

National Clearinghouse on Family Violence CEU



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