KODY, an all-of-family response to co-occurring substance use and domestic violence: protocol for a quasi-experimental intervention trial.

BACKGROUND: The co-occurrence of domestic violence with alcohol and other drugs significantly increases the severity of abuse and violence experienced by family members. Longitudinal studies indicate that substance use is one of few predictors of men's continued use of, or desistance from, violence. Recent developments in men's behaviour change programs have focused on men's attitudes and behaviour towards their children, and the exploration of interventions that address the needs of all family members. However, the research evidence is limited on the most effective elements of men's behaviour change programs in promoting the safety and wellbeing of child and women victim survivors. This study aims to build on the existing evidence by trialling the KODY program which addresses harmful substance use by men who also perpetrate domestic violence; the safety and wellbeing of women and children; the needs of children in their own right, as well as in relationship with their mothers; and the development of an 'all-of-family' service response. The evaluation of these innovations, and the ramifications for policy development to support less fragmented service system responses, provide the rationale for the study. METHODS/DESIGN: A quasi-experimental design will be used to assess the primary outcomes of improving the safety and wellbeing of mothers and children whose (ex)partners and fathers respectively participate in KODY (the trial program), when compared with 'Caring Dads standard' (the comparison group). Psychometric tests will be administered to fathers and mothers at baseline, post-program and at 3-month follow up. Data collection will occur over three years. DISCUSSION: By building the evidence base about responses to co-occurring domestic violence and substance use, this study aims to develop knowledge about improving safety outcomes for women and children, and to better understand appropriate support for children in families living at the intersection of domestic violence and substance use. It is anticipated that study findings will point to the ramifications for policy development to support less fragmented service system responses. TRIAL REGISTRATION: An application for registration with the Australian and New Zealand Clinical Trials Registry ( https://www.anzctr.org.au/ ) was lodged on 20 December 2021 (Request number: 383206)-prospectively registered.

"The Average Counsellor Wouldn't Know": Exploring How General Health Practitioners Understand and Respond to Domestic Violence.

BACKGROUND: Individuals experiencing and perpetrating intimate partner violence (IPV) are frequently in contact with general health and mental health services. Health service providers, including nurses, thus have a key role in identifying and responding to initial indicators of IPV risk. PURPOSE: The present study provides descriptive information about current assessment and intervention practices of health and mental health service providers when patients are presenting with concerns about IPV. METHODS: A secondary data analysis of interviews with general health practitioners (n = 17) were coded and dominant themes analyzed through thematic analysis. RESULTS: The present study uncovered ways in which IPV-related risks are, and are not, recognized and responded to. A metaphorical visual display in the form of a "domestic violence supply room" depicts the level of access and degree of competency described by practitioners in respective areas of practice. Within reach for all practitioners is the knowledge of factors that increase risk and vulnerability to IPV. Out of reach is a comprehensive understanding of the needs of children and perpetrators as well as the consistent ability to consider intersectionality and be reflexive when working with culturally and linguistically diverse populations. The step ladder to improved IPV response, including formal supports such as training and procedures, is frequently described as lacking. CONCLUSIONS: A consistent and empirically supported approach to IPV assessment and response is rare to find across generalist service provision. Although service providers possess basic knowledge of risk factors, organizational direction is needed to allow providers to address IPV confidently and effectively.

How domestically violent Fathers impact children's social-emotional development: Fathers' psychological functioning, parenting, and coparenting.

BACKGROUND: Most children exposed to father-perpetrated domestic violence (DV) continue to have contact or live with fathers, yet there is little research on the impact of fathering in the context of domestic violence. OBJECTIVE: This paper aimed to identify pathways from children's exposure to father-perpetrated DV to compromised social-emotional outcomes. Based on extant literature on fathering and domestic violence, psychological, parenting, and coparenting features in DV fathers were identified as potential mediators of the relationship between child exposure to DV and their social-emotional outcomes. PARTICIPANTS AND SETTING: Participants were 123 fathers with confirmed histories of DV perpetration and 101 comparison fathers without such histories. METHODS: Fathers completed self-report measures during two assessment sessions held at the university. Simple mediation analyses were used to examine pathways between fathers' DV perpetration and child internalizing and externalizing difficulties through potential mediators. RESULTS: Paternal depression, hostility, and coparenting difficulties significantly mediated the relationship between child exposure to DV and child internalizing and externalizing difficulties. Low paternal warmth was associated with child externalizing difficulties but did not function as a mediator. Paternal over-reactivity and laxness, in contrast, were not significantly correlated with DV perpetration or with child internalizing or externalizing outcomes. CONCLUSIONS: This study suggests that fathers' emotion regulation and coparenting difficulties are important correlates of his DV perpetration and of their children's psychological symptoms and should be considered as potential foci for parenting intervention with this population.

General Criminality as a Marker of Heterogeneity in Domestically Violent Men: Differences in Trauma History, Psychopathology, Neurocognitive Functioning, and Psychophysiology.

This study examined whether involvement in general criminal behavior was a useful marker of critical historic, psychological, and cognitive aspects of heterogeneity in domestically violent men. Two subgroups of domestically violent men, those with (n = 56) and without (n = 54) a history of criminal involvement, were compared with a group of nonviolent men (n = 82) on internalizing psychopathology, substance abuse, maltreatment in the family of origin, cognitive and executive functioning, and psychophysiological factors. Results found that domestically violent criminal men scored higher than the other two groups on a number of measures including history of childhood violence exposure, childhood externalizing behavior, and adult internalizing psychopathology. No differences were found on their psychophysiological reactivity and cognitive performance. The domestically violent noncriminal group and the comparison group were largely similar on study variables with the exception of education and substance use. Results suggest that general theories of antisocial behavior may be relevant and helpful for understanding domestically violent and criminally involved batterers, whereas social and family violence theories may be of greater relevance to noncriminally involved batterers. Implications of these results for intervention are considered.

Caring Dads intervention for fathers who have perpetrated abuse within their families: Quasi-experimental evaluation of child protection outcomes over two years.

BACKGROUND: In Canada, two of the most common forms of maltreatment substantiated by child protective services are child exposure to domestic violence and child physical abuse. Fathers are identified as the parent responsible for a substantial proportion of this maltreatment. OBJECTIVE: This study examined whether providing a group-based intervention program for fathers was associated with greater engagement of fathers in child protection case management and with lower rates of subsequent father-perpetrated abuse. PARTICIPANTS: A quasi-experimental design compared child protection outcomes in families in which fathers were referred to an intervention program (Caring Dads) and either completed the group (n = 85) or remained on a waitlist for future service (n = 100). METHODS: Data were collected from a retrospective review of administrative files over two years, starting from the time of referral to Caring Dads. RESULTS: Initial comparisons found no significant differences in intervention and comparison group fathers in demographic characteristics, child protection concerns, and all but one area of risk and needs. Completing intervention, as compared to being waitlisted, was associated with a greater number of contacts between child protection workers and fathers over two years (M = 30.3 vs. M = 16.7), a difference that was significant and large in size (d = 0.81) and with lower rates of verified re-referral due to fathers' maltreatment (20.5% vs. 36.0%), a difference that was significant and between small and medium in size (V = 0.17). CONCLUSIONS: Current results suggest that there may be significant benefits of involving fathers in child protection-linked intervention.

Attention biases and social-emotional development in preschool-aged children who have been exposed to domestic violence.

BACKGROUND: School-aged children and adolescents exposed to domestic violence (DV) disproportionality attend to threatening and sad cues in their environment. This bias in attention has been found to predict elevations in symptoms of psychopathology. Studies have yet to explore attention biases using eyetracking technology in preschool-aged children with DV exposure. OBJECTIVE: This study investigated whether preschool-aged children exposed to DV show vigilance to angry and sad faces versus happy faces and a target non-face stimulus relative to non-exposed children, and whether such vigilance relates to child social-emotional development. PARTICIPANTS AND SETTING: Preschool-aged children were recruited from a large, diverse, urban community. DV-exposed children were recruited from a dyadic, mother-child treatment group specifically designed for, and restricted to, mothers who have experienced domestic violence (DV-exposed group, n = 23). Children with no prior exposure to DV and their mothers were recruited within the same community (non-exposed group, n = 32). METHODS: Children completed an eye-tracking task to assess their attention to face stimuli and mothers rated their children's social-emotional development. Total duration of fixations were analyzed. RESULTS: Results showed that DV-exposed children have a significantly stronger attention bias away from sad faces (p = 0.03; d = 0.62) and neutral faces (p = 0.02; d = 0.70) relative to non-exposed children, and this attention bias away from sad and neutral faces is associated with child social-emotional problems. Contrary to our hypothesis, no bias towards anger was found for DV-exposed versus non-exposed children. CONCLUSIONS: This study contributes to growing evidence that young children's negative attention biases influence functioning and have important implications for children's well-being and development.

Resistance, reluctance, and readiness in perpetrators of abuse against women and children.

Perpetrators of abuse and violence against women and children are often reluctant participants in intervention programs. They frequently fail to attend scheduled appointments, are sometimes openly hostile to intervention staff, and often judge program materials as irrelevant to their situation. Recognizing this problem, researchers and practitioners have begun to develop models and tools to more appropriately assess and intervene with reluctant clients. Unfortunately, the resulting proliferation and inconsistent application of terms and theories have led to considerable confusion in characterizing reluctant clients and have significantly hampered research on strategies that may be helpful to better meet the needs of this client group. The purpose of this review is to help standardize the definition and measurement of treatment reluctance as it applies to violence perpetration and to review evidence for the importance of these aspects of client reluctance to intervention. Recommendations for assessing reluctance in research and clinical practice are also provided.

Understanding the link between childhood maltreatment and violent delinquency: what do schools have to add?

Child maltreatment constitutes significant risk for adolescent delinquency. Although an ecological model has been proposed to explain this relationship, most studies focus on individual risk factors. Prospective data from 1,788 students attending 23 schools were used to examine the additive influence of childhood maltreatment, individual-level risk factors, and school-level variables assessed at the beginning of Grade 9 on delinquency 4 to 6 months later. Individual-level results indicated that being male, experiencing childhood maltreatment, and poor parental nurturing were predictors of violent delinquency. School climate also played a significant role: Given the same individual risk profile, a student attending a school that was perceived by students as safe was less likely to engage in violent delinquency than was a student attending a school perceived to be unsafe. Moreover, the impact of childhood maltreatment on risk for engaging in violent delinquency was somewhat mitigated by schools' participation in a comprehensive violence prevention program.

Denial, minimization, partner blaming, and intimate aggression in dating partners.

Although countering denial, minimization, and externalization of blame is a key component of most interventions for individuals who have been abusive in their intimate relationships, these attributions have only seldom been the focus of empirical investigation. Using a sample of 139 male and female university students, this study examined the associations between self-reported minimizing and blaming attributions and the perpetration of physical, sexual, and psychological aggression against an intimate partner. For men, minimization of conflict and partner blame were associated with self-reported perpetration of intimate partner aggression, even after controlling for socially desirable responding and relationship satisfaction. In contrast, women's aggression was associated only with partner blame. Discussion focuses on overlap with similar areas of research, gender differences in minimization and blaming, and on potential directions for further empirical work on the associations of intimate aggression, relationship dissatisfaction, and attribution.

Intervening to prevent repeat offending among moderate- to high-risk domestic violence offenders: a second-responder program for men.

Clear directions about best strategies to reduce recidivism among domestic violence offenders have remained elusive. The current study offers an initial evaluation of an RNR (Risk, Needs, and Responsivity)-focused second-responder program for men accused of assaulting their intimate partners and who were judged as being at moderate to high risk for re-offending. A quasi-experimental design was used to compare police outcomes for 40 men attending a second-responder intervention program to 40 men with equivalent levels of risk for re-offense who did not attend intervention (comparison group). Results showed that there were significant, substantial, and lasting differences across groups in all outcome domains. In terms of recidivism, rates of subsequent domestic-violence-related changes were more than double for men in the comparison group as compared with the intervention group in both 1-year (65.9% vs. 29.3%) and 2-year (41.5% vs. 12.2%) follow-up. Changes in the rates of arrest were consistent with reductions in men's general involvement with police, with men in the intervention group receiving fewer charges for violent offenses, administrative offenses, and property offenses over the 2 years following intervention than men in the comparison group. Not surprisingly, these differences result in a much lower estimated amount of police time with intervention men than for comparison men. Results are discussed with reference to the possible impact of sharing information with men about their assessed risk for re-offending within a therapeutic justice context.

Factors associated with atypical speech representation in children with intractable epilepsy.

The purpose of this study was to investigate the relationship between hemispheric speech dominance and several demographic and seizure variables in a large sample of children (N=75) who underwent the intracarotid amobarbital procedure (IAP) prior to surgery. The findings were similar to results previously reported in adults and children, suggesting that variables, such as age at seizure onset, laterality of seizure focus, location of seizure focus and handedness are related to the presentation of atypical speech representation in children with epilepsy. The impact of multiple variables in determining the risk for atypical speech dominance was also assessed. The results demonstrated an increased probability of atypical speech representation in children with a greater number of risk variables, suggesting the need for further investigations in this area.

Readiness to change as a predictor of outcome in batterer treatment.

The current study examined stage of change as a predictor of outcome in batterer treatment. Men (N=119) were classified into the transtheoretical model's stages of change and assessed 3 times over treatment. Hierarchical linear modeling revealed significant variation in men's progress, predictable from their stage of change. As hypothesized, men in the precontemplation stage showed little positive change in empathy, communication, or abusive behavior, whereas men in the contemplation and action stages showed positive growth in all of these domains. These effects occurred in the initial 10 weeks of treatment, after which men progressed at a more homogeneous rate. Interpretation is complicated by pretreatment differences that draw into question stage-related patterns in final outcome. Implications for general models of abuse cessation and for stage-specific trajectories are discussed.

Dating violence prevention with at-risk youth: a controlled outcome evaluation.

This study evaluated a community-based intervention to help at-risk teens develop healthy, nonabusive relationships with dating partners. Participants were 158 14-16-year-olds with histories of child maltreatment who were randomly assigned to a preventive intervention group or a no-treatment control group. They completed measures of abuse and victimization with dating partners, emotional distress, and healthy relationship skills at bimonthly intervals when dating someone. Intervention consisted of education about healthy and abusive relationships, conflict resolution and communication skills, and social action activities. Growth curve analyses showed that intervention was effective in reducing incidents of physical and emotional abuse and symptoms of emotional distress over-time. Findings support involvement of youths in reducing the cycle of violence as they initiate dating in midadolescence.

Predicting abuse in adolescent dating relationships over 1 year: the role of child maltreatment and trauma.

Three mediators of the relationship between childhood maltreatment and dating violence perpetration during midadolescence (i.e., trauma-related symptoms, attitudes justifying dating violence, and empathy and self-efficacy in dating relationships) were tested over 1 year with a sample of students from 10 high schools (N = 1,317). Trauma-related symptoms had a significant cross-time effect on predicting incidents of dating violence for both boys and girls. Attitudes and empathy and self-efficacy did not predict dating violence over time, although they were correlated with such behavior at both time points. Child maltreatment is a distal risk factor for adolescent dating violence, and trauma-related symptoms act as a significant mediator of this relationship. The importance of longitudinal methodology that separates correlates from predictors is discussed.

Maltreatment and trauma: tracking the connections in adolescence.

Posttraumatic stress disorder is one of the most common and often prolonged consequences of childhood maltreatment. In this article the authors consider theories of trauma continuity, with emphasis on a relational path to maladjustment that links childhood maltreatment to elevated trauma symptomatology and intimate victimization in adolescent dating relationships.

Predictors of change among male batterers: application of theories and review of empirical findings.

The efficacy of batterer treatment is a concern of clinicians, researchers, and policy makers. Most past research on batterer treatment has defined success as a cessation of men's physical abuse against their intimate partner. Although clearly an important outcome, focus on assault leaves many questions unanswered about the broader impact of batterer treatment and the processes through which successful change may be promoted. With the aim of encouraging complexity in the consideration of change among batterers, the current article reviews studies that go beyond dichotomous outcomes. First, evidence for the success of batterer treatment is considered from multiple perspectives: men's, women's, and the intervention system. Next, an in-depth review of research on factors relating to change in abusive men is completed using feminist, family systems, individual, and typology theories as an organizing framework. Numerous recommendations are made for integrating theories of change with investigations of treatment success in future work.

Why are suspected cases of child maltreatment referred by educators so often unsubstantiated?

School professionals have a unique vantage point for identifying child maltreatment and they are a frequent source of referral to child protective services. Disturbingly, past studies have found that maltreatment concerns reported by educators go unsubstantiated by child protective services at much higher rates than suspected maltreatment reported by other professionals. This study explores whether there are systematic differences in the characteristics of cases reported by educators as compared to other professionals and examines whether such variation might account for differences in investigation outcome. Analyses were based on 7,725 cases of suspected maltreatment referred by professionals to child protective services from the Canadian Incidence Study of Reported Child Abuse and Neglect - 2003 a national database on the characteristics of children and families investigated by child protective services. School professionals were responsible for 35.8% of professional referrals. Reports by educators were much more likely to be unsubstantiated (45.3%) than those by other professionals (28.4%) in subsequent child protective investigation. Cases reported by educators were found to contain significantly more child risk factors (e.g., child emotional and behavioural problems) and fewer caregiver and family risk factors (e.g., caregiver mental health problem, single parent family) than cases reported by other professionals. Even controlling for these differences, educator-reported concerns were still 1.84, 95% CI [1.41, 2.40] times as likely to be unsubstantiated as reports from other professionals. Contrary to the notion that educators are mostly reporting non-severe cases, suspected/substantiated cases reported by school professionals were more likely to be judged as chronic and more likely to involve families with a previous child protection history. Results are concerning for the capacity of the education and child protection systems to work together to meet their shared goal of promoting healthy child development. Additional research is needed on the way in which child risks and problems influence child protective service, particularly in the context of chronic abuse and neglect and lack of availability of child and family mental health interventions. Potential problems with credibility of school professionals as reporters of child maltreatment concerns also warrant further investigation.

The (dubious?) benefits of second chances in batterer intervention programs.

In batterer intervention programs, there are conflicting recommendations about best practices for responding to client dropout. Risk management philosophies emphasize the importance of swift and sure sanctions for failure to comply with program attendance requirements. In contrast, change theory emphasizes the importance of providing clients with multiple opportunities to engage in treatment. To clarify the implications of each of these philosophies, the current study examined rates of program dropout, reinstatement, and completion in a consecutive sample of 294 probation-mandated clients referred to a large batterer intervention program. Just over half (53.7%) of men completed intervention on their first attempt. Over the 2-year follow-up study period, 73 clients were reinstated once by the intervention program, 23 clients were reinstated twice, and 5 clients reinstated three (or more) times. Reinstated clients were, in general, more similar to men who failed to complete than those who completed on their first attempt. Although rates of dropout at each reentry point were quite high (56% to 80%), 32 of the 73 (43.7%) reinstated clients eventually completed. There were significant costs associated with providing clients with additional chances to complete the program, with successful reinstatement requiring an average of 7.55 phone calls to clients, 3.82 phone calls to referral agents, one letter, and 0.73 in-person meetings. Results are discussed in terms of practice and policy implications of risk management and change theory approaches to dropout.

Intervention for maltreating fathers: statistically and clinically significant change.

OBJECTIVE: Fathers are seldom the focus of efforts to address child maltreatment and little is currently known about the effectiveness of intervention for this population. To address this gap, we examined the efficacy of a community-based group treatment program for fathers who had abused or neglected their children or exposed their children to domestic violence. METHODS: Using a sample of 98 group participants, we examined the magnitude and clinical significance of pre- to post-intervention changes in parenting, co-parenting and generalized aggression. RESULTS: Intervention led to considerable changes in fathers' over-reactivity to children's misbehavior and respect for their partner's commitment and judgment, with results being statistically significant, medium in size, moving mean scores into the normative range and with 36-43% of men who initially scored in the clinical range recovering by the end of intervention. Changes in other domains were also evident though of lesser magnitude. CONCLUSIONS: Although this study is limited in length of follow-up and the lack of a control group, results are promising for continued development of fathering interventions for this population of high-risk men.

Impact of a universal school-based violence prevention program on violent delinquency: distinctive benefits for youth with maltreatment histories.

OBJECTIVE: Child maltreatment constitutes a strong risk factor for violent delinquency in adolescence, with cumulative experiences of maltreatment creating increasingly greater risk. Our previous work demonstrated that a universal school-based violence prevention program could provide a protective impact for youth at risk for violent delinquency due to child maltreatment history. In this study we conducted a follow-up to determine if participation in a school-based violence prevention program in grade 9 continued to provide a buffering effect on engaging in acts of violent delinquency for maltreated youth, 2 years post-intervention. METHODS: Secondary analyses were conducted using data from a cluster randomized controlled trial of a comprehensive school-based violence prevention program. Students (N=1,722; 52.8% female) from 20 schools participated in 21 75-min lessons in grade 9 health classes. Individual data (i.e., gender, child maltreatment experiences, and violent delinquency in grade 9) and school-level data (i.e., student perception of safety averaged across students in each school) were entered in a multilevel model to predict violent delinquency at the end of grade 11. RESULTS: Individual- and school-level factors predicting violent delinquency in grade 11 replicated previous findings from grade 9: being male, experiencing child maltreatment, being violent in grade 9, and attending a school with a lower perceived sense of safety among the entire student body increased violent delinquency. The cross-level interaction of individual maltreatment history and school-level intervention was also replicated: in non-intervention schools, youth with more maltreatment in their background were increasingly likely to engage in violent delinquency. The strength of this relationship was significantly attenuated in intervention schools. CONCLUSIONS: Follow-up findings are consistent with the buffering effect of the prevention program previously found post-intervention for the subsample of youth with maltreatment histories. PRACTICE IMPLICATIONS: A relative inexpensive school-based violence prevention program that has been shown to reduce dating violence among the whole student body also creates a protective effect for maltreated youth with respect to lowering their likelihood of engaging in violent delinquency.