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Assessment of Family Violence: A Clinical and Legal Sourcebook
Almost every mental health professional is faced with evaluating individuals and families involved in domestic violence, including child abuse and neglect, incest, battering, elder abuse, and psychological abuse. This valuable resource is the only book exclusively devoted to the assessment of all types of family violence and explains how to determine if family violence is occurring. Through the work and contributions of preeminent researchers and practitioners, the Second Edition includes:
* State-of-the-art, empirically driven approaches to the clinical evaluation of violence involving children and adults
* Specific assessment measures to assess future risk and specialized issues, such as children who have witnessed marital violence and adult incest survivors
* Case examples and a new chapter on child neglect
* Current issues in the assessment of family violence, child maltreatment, and couples violence
* Assessment of elder abuse, woman battering, and extrafamilial child sexual abuse.
Critical Acclaim for the First Edition
"A rare combination of excellent writing and editing, up-to-date and carefully presented reviews of the knowledge base, and practical and useful information about treatment and prevention. Of the many books that have been published in the last few years on family violence, this is one of the most valuable." —Child Abuse and Neglect.
"This book will come as a necessary and welcome addition to the libraries of therapists from different theoretical orientations and with differing levels of experience who encounter family violence in their practice." —Contemporary Psychology.
Disc. assessment of family violence, child mal- treatment, couples violence, elder abuse, etc.
Current Issues in the Assessment of Family Violence: An Update (R. Ammerman & M. Hersen).
Clinical Issues in the Assessment of Family Violence Involving Children (J. Fantuzzo, et al.).
Clinical Issues in the Assessment of Partner Violence (K. O'Leary & C. Murphy).
Legal and Systems Issues in the Assessment of Family Violence Involving Children (S. Azar & C. Soysa).
Legal and Systems Issues in the Assessment of Family Violence Involving Adults (R. Thyfault).
Epidemiology of Family Violence Involving Children (J. Haugaard).
Epidemiology of Intimate Partner Violence and Other Family Violence Involving Adults (R. Bachman).
TYPES OF FAMILY VIOLENCE.
Child Physical Abuse (D. Hansen, et al.).
Child Neglect (R. Gershater-Molko & J. Lutzker).
Incest in Young Children (L. Damon & J. Card).
Extrafamilial Child Sexual Abuse (S. McLeer & M. Rose).
Woman Battering (D. Saunders).
Elder Abuse and Neglect (R. Adelman, et al.).
Psychological Maltreatment of Children (P. Berlin & J. Vondra).
Psychological Maltreatment of Women (R. Tolman, et al.).
Child Witnesses of Domestic Violence (M. Sudermann & P. Jaffe).
Adolescent Perpetrators of Sexual Abuse (W. Murphy & I. Page).
Adult Survivors of Sexual Abuse (S. Gold & L. Brown).
Current Issues in the Assessment of Family Violence: An Update
EVEN BY conservative estimates, family violence is endemic in society. Although not a new problem, only in the last 20 years has family violence been subjected to empirical scrutiny. However, determining accurate prevalence and incidence rates of abuse and neglect is extremely difficult, due largely to the fact that domestic mistreatment is a private event, rarely open to public observation. Further impediments to accurate epidemiological research on family violence include failure to arrive at consensus definitions of the different forms of maltreatment (Gelles, 1997; National Research Council, 1993), and methodological limitations of the data gathering strategies that are typically employed (see Ammerman, 1998). Nevertheless, official reporting agencies and population surveys reveal the pervasiveness of family violence. For example, about 970,000 children in the United States were found by child protective agencies to have been abused or neglected in 1996 (U. S. Department of Health and Human Services, 1998). It is likely that the official reporting statistics underestimate the true incidence of child maltreatment. Spouse battering is also widespread, estimated to occur in up to two million households per year (Straus & Gelles, 1986).
More recently, research has focused on previously overlooked victims of domestic violence, such as child and adult targets of psychological abuse, child witnesses of spouse battering, and ritually abused children. Epidemiological data on these forms of mistreatment are only now emerging, although it is widely viewed that psychological or emotional abuse (Brassard, Hart, & Hardy, in press) and child witnessing of interparental violence (Fantuzzo, Boruch, Beriama, Atkins, & Marcus, 1997) are relatively common. Finally, the maltreatment of elderly family members also occurs at alarming rates. Up to one million elderly persons are believed to be mistreated each year (see Goldstein, 1996; Straus & Gelles, 1986).
Equally impressive are data documenting the prevalence of mistreatment in clinic populations. Retrospective studies of psychiatrically hospitalized patients reveal that between 40% and 70% have experienced abuse and/ or neglect at some point in their lives (e. g., Ammerman, Hersen, Van Hasselt, Lubetsky, & Sieck, 1994; Monane, Leichter, & Lewis, 1984). High levels of mistreatment have been documented in various types of psychopathology encompassing such diverse psychiatric conditions as conduct disorder, borderline personality disorder, personality disorder, major depression, and substance use disorders (see Malinoski-Rummell & Hansen, 1993). Taken together, these findings highlight the fact that a history of family violence is a concomitant feature of many patients seeking treatment. The likelihood of a clinician encountering past or current mistreatment is overwhelming, and it behooves all mental health professionals to be familiar with the detection, assessment, and treatment of family violence.
Evidence is accruing that establishes a casual link between maltreatment and short-and long-term psychopathology in victims. In children, physically abused and neglected infants typically have insecure attachments with caregivers (see Cicchetti & Toth, 1995). This, in turn, places these children at high risk for further disruptions and lags in social, emotional, and cognitive development. Disturbances during this crucial period in the formation of trusting relationships are viewed as important to adult interpersonal functioning and the intergenerational transmission of abuse (Belsky, 1993). Child victims of sexual abuse also suffer a variety of consequences secondary to molestation. Depression, anxiety, and symptoms of posttraumatic stress disorder (e. g., nightmares, flashbacks, excessive vigilance) are possible sequelae. Survivors of incest and sexual abuse also suffer and often carry these problems into adulthood. Posttraumatic stress syndrome is also found in victims of spouse battering and elder abuse. Low self-esteem, depression, and anxiety are relatively common in these individuals. When combined with the increased risk of physical injury, the consequences of family violence for its victims are varied and often severe.
The etiology of family violence is equally complex. It is universally acknowledged that the abuse and neglect of children and adults are multidetermined, incorporating causal influences from individual, family system, and societal sources (see Ammerman & Galvin, 1998; Belsky, 1993). Their onset is insidious. Moreover, family violence almost never occurs in isolation and is inextricably linked with events, situations, and states (e. g., unemployment, crowding, alcoholism, poverty, poor parenting skills, and psychiatric disorders) that can by themselves lead to deleterious consequences. The assessment of family violence must take into account the multifaceted influences that may play causative roles in, or be effects of, maltreatment. Assessment strategies need to be comprehensive and thorough. Moreover, there is no unique and specific constellation of symptoms for victims or perpetrators of any form of family violence. As such, assessment should be broad in scope. As the chapters in this volume indicate, there are few measures or approaches that are specifically designed for assessing family violence.
PRACTICAL CONSIDERATIONSA number of issues interfere with the assessment process. The first and most difficult step in assessment is identification. There are at least two obstacles in recognizing family violence. Much of the difficulty stems from the fact that mistreatment is a private event. Victims are often reluctant to disclose abuse. Some fear retribution from the perpetrator. This fear is most clearly exemplified in spouse battering, in which abused women's fear for their lives is understandable given the alarming incidence of domestic homicide (see Saunders & Browne, in press). Others fear dissolution of the family and the negative effects (e. g., financial loss) resulting from the perpetrator's leaving the home. Maltreated children may be especially affected by this fear. Elderly persons, too, may be reluctant to lose the economic support and care ( however meager these may be) provided by the perpetrators. For those child and adult victims who do not disclose mistreatment on their own, friends, neighbors, and professionals must be relied upon to expose domestic violence and direct the family to appropriate services.
METHODOLOGICAL AND PSYCHOMETRIC CONSIDERATIONS
The private nature of family violence poses considerable challenges to assessment. Because abuse is rarely observed directly (physical neglect, on the other hand, is more directly observed), clinicians must rely solely on interviews, questionnaires, and direct observations. Unfortunately, these approaches are highly prone to bias and error. The social undesirability (and possible criminal consequences) of domestic abuse leads many perpetrators to minimize, distort, or deny the occurrence of mistreatment. Victims, too, are often reluctant to disclose mistreatment, or as an emotional defense mechanism, they may minimize it.
In the assessment of family violence, the clinical interview is the most important information gathering approach. The general consensus among professionals is that victims and perpetrators should be interviewed separately to avoid intimidation by the perpetrator. This is especially true with sexual abuse of young children, in which confrontation of the victim by the perpetrator is highly undesirable. Interviewing couples and families together (particularly when it is evident that the family will remain intact) also can be helpful, although separate services for the perpetrator and victim( s) may be required. In some cases, the interview process is lengthy and indistinguishable from therapy. The adult survivor of incest, for example, may come to terms with his or her experiences only gradually through careful and prolonged exploration. Young children, too, may reveal details of sexual mistreatment only after numerous sessions of play and evaluation. In other cases, such as when the victim seeks help secondary to mistreatment, the interview is more structured and straightforward. Several structured interviews have emerged in the family violence field. For example, the Child Abuse and Neglect Interview Schedule-Revised (CANIS-R; Ammerman, Hersen, & Van Hasselt, 1988) provides a comprehensive review of parental disciplinary practices, child behavior, family history, and other relevant aspects of domestic violence and neglect. The psychometric properties of this instrument are good (Ammerman et al., 1994).
Unfortunately, interviews are prone to bias, distortion, and memory problems. Variations in interview format can yield different information. External validity also is called into question, largely due to the inaccessibility of mistreatment to observation. Thus, interviews are a critical, albeit flawed, component to the assessment of family violence.
Self-report questionnaires also play an important role in assessment. The majority of self-report measures used in family violence are drawn from other areas, such as adult and child psychopathology, and marital and family adjustment. However, there is a growing body of instruments developed specifically for victims and perpetrators of family violence. Included are the Conflict Tactics Scale (Straus, 1979) and the Child Abuse Potential Inventory (Milner, 1986). The Child Abuse Potential Inventory, in particular, has been developed and evaluated using stringent psychometric criteria. Problems of distortion and fabrication threaten the validity of many of these measures, further complicating the utility of self-report indices in family violence assessment. Additional efforts in this area are clearly warranted.
Another assessment approach is direct observation. Structure observation strategies using ratings by trained coders are a mainstay of research in family violence, particularly in the area of child maltreatment. Spouse battering has also been examined using direct observation, although observational assessment strategies with family violence involving adults are less well developed than those involving children. The resources needed to carry out such direct observational approaches typically preclude their use in clinical settings. In general, observations of parent-child or couple interactions in the clinics are less formal, relying more on the assessor's subjective impressions.
CONTENT CONSIDERATIONSThe assessment of family violence targets two broad areas: specifics about the mistreatment and psychosocial/physical functioning. The importance of the details of mistreatment has only recently been understood. Type of mistreatment, length of abuse and neglect, and associated features all influence the consequences exhibited and also impact treatment planning. Collecting such information is also important in anticipation of legal involvement. Another recent recognition is that the negative quality of the interactions between family members is a more important mediator of severity of consequences than the acts of maltreatment per se (e. g., Wolfe & McEachran, 1997). However, this does not obviate the need to carefully document what happened, when it happened, and how long it has been occurring. Several interviews and questionnaires have been developed to assist the clinician in this endeavor (e. g., Ammerman, Hersen, & Van Hasselt, 1988).
LEGAL AND SYSTEMS CONSIDERATIONSInterfacing with the legal system is inevitable in working with family violence cases. All states in the United States and provinces in Canada have laws requiring that professionals report suspected incidents of child maltreatment. Many states also obligate the reporting of mistreatment of the elderly. Frequently, clinicians see individuals and families after they have become involved with a protective service, or after they have had contact with some aspect of the legal system (e. g., the police).
CONCLUSIONRecent empirical research has more clearly defined the role of assessment in the treatment of family violence. Although still in the early stages of development, guidelines for practice have emerged for diverse forms of family violence, including spouse battering, child abuse and neglect, elder mistreatment, and psychological maltreatment of children and adults. Nevertheless, significant practical and methodological impediments to assessment await further investigative attention. It is evident, however, that a comprehensive approach addressing multiple aspects of individual and family functioning is the sine qua non of assessment. While the measures employed will no doubt be further refined, the complexity of family violence ensures that a multidimensional assessment will be required.