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The topic to be discussed in this paper is that of domestic violence and how being exposed to this violence affects children of different ethnicities/cultures. According to the American Professional Society on the Abuse of Children's (APSAC) handbook intimate partner violence can be used interchangeably as a term with domestic violence, partner violence and family violence (p.167). For purposes of this paper the terms domestic violence and IPV will be used interchangeably as much scholarly research does not make a distinction between the two. However, the way in which IPV differs from domestic violence is that it can exist from a single episode to an ongoing continuum of battering (Center for Disease Control and Prevention, 2010) as opposed to domestic violence which is a continuing pattern of control once it begins. Domestic violence is an area of maltreatment that affects children across all ethnicities and cultures in many ways. This includes adverse effects on children's physical, cognitive, emotional and social development (Osofsky, 2003, p. 34). Violence is a public health problem and children are vulnerable to its effects. Family violence and community violence are related to aggression, depression, posttraumatic stress disorder and academic and cognitive difficulties. ((Margolin & Gordis, 2004, p. 153) Domestic violence will affect one out of four families in a lifetime (NYSCADV, 2004). Intimate partner violence is defined as a serious, preventable public health problem that affects millions of Americans. The term "intimate partner violence" describes physical, sexual or psychological abuse by a current or former partner or spouse. This type of violence can occur among heterosexual or same-sex couples and does not require sexual intimacy (Center for Disease Control and Prevention, 2010, 10). Another definition which further highlights and broadens the scope and seriousness of this issue is: domestic violence is abusive behavior-emotional, psychological, physical or sexual-that one person in an intimate relationship uses in order to control the other. It takes many different forms and includes behaviors such as threats, name calling, preventing contact with family and friends, withholding money, actual or threatened physical harm and sexual assault. (NYSCADV, 2004). Holden (2003) discusses the fact that the term domestic violence is used most frequently as it more inclusive than other terms such as partner violence, marital violence, interpersonal violence and wife abuse, hence the use of it for our purposes.
The impact of witnessing domestic violence for children has come to the forefront of America's consciousness only recently. Straus, Gelles amd Steinmartz report in their 1980 study that contrary to popular belief Americans homes are not "havens of safety" (Myers, 2011, p. 169). In a study by Graham-Bermann, Gruber, Girz & Howell mothers reported that children witnessed 78% of severe violence in the home (Myers, 2011, p. 169). An additional study shows that children who witness IPV are 15 times more likely to be abused as compared to the national average (Osofsky, 2003). A child is more likely to be assaulted, beaten or killed by their own family members than by outsiders (Myers, 2011, p. 169). There is a consensus that children's exposure to domestic violence negatively affects children's health and development. According to Wolfe et al. exposure to domestic violence interferes with normal development and leads to unpredictable but generally negative, outcomes in the short- and long term (p.171). In addition to the physical effects of bodily harm (if the children are also physically assaulted during the incident) research indicates that exposure to violence may disrupt children's psychological outcomes in numerous ways (Fantuzzo and Mohr1999; Margolin 1998; Rossman 2001). "Intimate partner violence had deleterious effects on all members of the family, further highlighting the need for efficacious treatments for the perpetrators, their partners and child witnesses of IPV" (Stover, Meadows, & Kaufman, 2009, p. 224).
Children who are exposed to domestic violence can be said to be victims of different types of maltreatment according to Holden (2003). He states that children exposed to domestic violence qualify as maltreated because they are living in an environment that is psychologically abusive. According to Hart, Brassard and Karlson psychological maltreatment is designed as "the repeated pattern of behavior that conveys to children that they are worthless, unloved, unwanted, only in value if meeting another's needs, or seriously threatened with physical or psychological violence" (p.73). Holden (2003) categorizes psychological maltreatment in six separate categories of which he states these children fall into most if not all, they are: being terrorized: the child lives in fear of having a loved one or objects in recognizable danger. The next is corrupting: this includes modeling misogynistic behavior, substance abuse or aggression. The next is spurning: verbal or non-verbal acts such as calling the child names in order to degrade. The next is denial of appropriate emotional response: the father is uninvolved and the mother is unable to attend to the child emotionally. The next is isolation: father isolates child or family or child isolates itself to avoid batterer. And finally is neglect of medical, mental health or educational needs: this includes not taking a child to necessary appointments, failure to meet child's needs in these areas. Not only are these children psychologically maltreated but studies show that there is a high rate of overlap between domestic violence and child physical abuse (Holden, 2003). A review of 30 empirical studies by Appel and Holden found that 30-60% of the children of battered women are abused (1998). Holden also states that "although little attention has been devoted to the overlap between domestic violence and sexual abuse" (p.158). This is another area of abuse that may be a by-product of domestic violence. A study by McCloskey, Figueredo and Koss reported that 10% of mothers in their study reported their children had been sexually abused by partners. Exposure to domestic violence can also be considered emotional abuse according to APSAC (Myers, 2011). O'Hagan (1995) defines emotional abuse as "the sustained, repetitive, inappropriate emotional response to the child's experience of emotion and its accompanying expressive behavior" (p.456.) By examining this issue through an ecological framework we can study outcomes for children exposed to domestic violence on both developmental and mental health milestones. The stressors within a family such as poverty, living in a crime filled neighborhood, and low education attainment may all lead to an enhanced likelihood of violence within the family and the children being witness or victim to this violence. Children exposed to domestic violence as also have problems across the life span depending on at what point the abuse occurs. Research suggest that if abuse takes place in early childhood the difference between an abused child and non-abused child can be seen in how they react to their caretaker when stressed (Hampton, 1999, p. 51). Children who have been physically abused and left alone in a strange situation, at 12 months of age and then reunited with their parent tend to avoid contact with that parent and maintain distance (Browne & Saqi, 1988, p. 171). In middle and late childhood abused children compared to their non-abused counterparts showed lower test scores on tests of general intellectual abilities (Vondra, Barnett, & Cicchetti, 1990, p. 538). During this time children from abusive families also exhibit affective and behavioral difficulties such as depression, sleep disturbance, self-destructive behaviors and social detachment (Hampton, 1999, p. 51). There is also evidence that the level of maladjustment is directly related to the severity of abuse the child either received/observed (Ybarra, Wilkens, & Lieberman, 2007, p. 34). It has also been reported that children with physical abuse also act out more physically as reported by their peers (Hampton, 1999, p. 52). According to Dodge, Bates and Petit (1990) children who are physically abused are also not meeting or having difficulty with developmental milestones in social development in early childhood as they appear to be less empathetic, reacting aggressively to distressed counterparts (p.1680). In the adolescent years children who are physically abused often turn to substance abuse as a coping mechanism and begin to associate with delinquent peers and partake in far more delinquent activities than their peers who have not been physically abused (Hampton, 1999, p. 54). As adults those who were victims of physical abuse due to domestic violence were more likely to be involved in criminal behavior. (Hampton, 1999, p. 54). These findings, like many concerning domestic violence can be disputed. Because many individuals experience various types of abuse, neglect and maltreatment it would be difficult to discern exactly what perpetuated an individual becoming involved with the penal system. Lastly, Hampton discusses the intergenerational transmission of physical abuse as another developmental marker that children who were victims of domestic violence carry with them into adulthood. This hypotheses state that patterns of violent behavior and physical abuse are carried from one generation to another through learned behavior and that victims of childhood physical abuse will go on to abuse their own children (Hampton, 1999, p. 55). All of these
Estimates regarding the percentages of intrafamial violence vary from 16% (Gelles and Straus, 1988) to 60% (O'Leary, Cury, Rosenbaum and Clarke, 1985). Just as these studies seem to contradict each other, so do studies that attempt to show that domestic violence is related to ethnicity. A recent study by Wang, Horne, Holford and Henning (2008) includes the information that 80% of the men who witnessed and then committed domestic violence were African-American; this study however was conducted in a larger southern metropolis, where the men could have been victims of profiling or the dominant ethnicity. O'Keefe states that studies show that spousal abuse is more prevalent in minority populations, particularly among African-Americans families, other investigators found no racial/ethnic differences (O'Keefe, 1994, p. 287) Domestic violence and family violence is found throughout all socioeconomic groups and ethnicities but the cause is not as of yet known. Debate waffles between ethnicity and socioeconomic status and class variables. The First Family Violence Survey, Straus et al. (1980) reported that African-American husbands had higher rates of overall violence and severe violence toward their wives than white husbands. (O'Keefe, 1994, p. 284) O'Keefe also suggests that since African-Americans have only recently achieved middle class status and that they may have retained some of the norms that are rooted in lower socio-economic status and that this combined with stress and uncertainty of this new class position may influence the use of violence (O'Keefe, 1994, p. 285). In another analysis of this study Cazanave and Straus find that when income levels were controlled white husbands were more likely to slap their wives than African-American husbands (O'Keefe, 1994, p. 285). Again, no definitive proof can be offered here as to what causes domestic violence. Concerning the effects on African-American children exposed to domestic violence, Thompson, Jr. and Massat state that exposure to traumatic and violent events leads to posttraumatic stress disorder (PTSD), behavior problems, and reduced academic achievement. They also found that witnessing violence was significantly related to exposure to family violence and PTSD and that frequency of exposure to family violence and community violence was significantly related to the child's level of behavior problems for African American children (Thompson & Rippey Massat, 2005, p. 387).
For children of Hispanic family's previous research by the authors and others has revealed violence to be a way of dealing with conflict in many Hispanic families (Mattson & Ruiz, 2005, p. 524). In order for a Hispanic woman to consider hitting and verbal abuse to be actual abuse it has to occur often (Bonilla-Santiago, 2002, p. 468). Hispanics are also more tolerant of abuse. Many studies indicate that children who witness domestic violence suffer from depression, PTSD, and violent and avoidant behaviors and these effects are well documented in literature. These outcomes are similar to those of African -American children. Societies that emphasize rigid sex role differentiation are rooted in patriarchal systems, have values that objectify women, and are believed to produce a familial context that is ripe for spousal abuse (Flores-Ortiz, 1993). These types of beliefs are found in many Hispanic families. When referring to what leads to domestic violence in Hispanic culture the authors refer to a phenomenon of machismo. This denotes a strong or overdeveloped sense of masculine pride. Participants in a study by the authors' stated that they believed the only way to bring their partner back in line was to "give her a little slap (Mattson & Ruiz, 2005, p. 526). Hispanic women reported that their reason for staying with abusive partners included children, needing financial support, having nowhere to go, and remaining with because their family/church supported it (Mattson & Ruiz, 2005, p. 526). These are reasons that are reported among all ethnicities and are not exclusive to this population. Another aspect of domestic violence in Hispanic culture is known as marianismo. This is the belief by Hispanic women that they are to bear everything for the sake of their family (Mattson & Ruiz, 2005, p. 527). This belief also teaches the woman not to go against the wishes of her husband even if they are potentially harmful to her or her children. As with the African-American culture there are studies that discount culture as playing a role in determining the prevalence of domestic violence in Hispanic families. Sorenson and Telles conducted a study called the Los Angeles Epidemiologic Catchment Area (ECA) survey. This survey studied 1,243 Mexican-Americans and 1,140 non-Hispanic Whites. The study showed that Mexican-Americans born in Mexico had a virtually identical domestic violence rate (20.0%) as non-Hispanic whites (21.6%) (Hampton, 1999, p. 174). In this study it was also revealed that Mexicans born in the United States had a much higher rate of domestic violence at 30% and also reported that female rates of domestic violence were much higher (Hampton, 1999, p. 174). An important finding in this study was that when factors such as economic deprivation, urban residence and youthfulness were controlled there is no significant difference between Hispanics and non-Hispanic whites in the commission of domestic violence (Hampton, 1999, p. 174). In addition discrepancies in the family's familial culture of origin and the dominant culture in which they reside may provide for higher rates in domestic violence among American born Mexicans. This finding is interesting in that other authors noted earlier that Hispanic culture dictates that men exert control over women. The question then becomes is this a cultural belief or an American belief system causing the violence.
Until recently Native American domestic violence and its effect on children is a culture that has been studied very little. Studies indicate that domestic violence incidents are occurring at alarming rates amid this population. According to Mitka (2002) the reason for this disproportional rate of domestic violence is due to the legacy of colonialism, oppression, subjugation and the subsequent trauma and current high poverty rates, encounters with racism, high rates of abuse of alcohol and drugs and isolation, particularly in rural areas. Of the total population 55% of Native Americans live below 200% of the federal poverty level, 38% of the 2.5 million who self-identify as Native American are under the age of eighteen meaning that they may require adult care and/or supervision. There is one reported case of child abuse for every 30 children and 27% of adults report childhood physical abuse. The Center for Disease Control also reports that 67% of women report some type of domestic violence has been perpetrated against them (Center for Disease Control and Prevention , 2010). Jones found that in a study that isolation was one main factor in domestic violence prevalence among Native Americans. The study which was conducted in a rural setting, which is the setting for most Indian territories, states that "because the population is dispersed so vastly that it is difficult to know and react when domestic violence is occurring. Victims may also learn apathy when they report a problem because they sense there is nothing that will be done when they do" (Jones, 2008, p. 115). Like other cultures Jones also finds that lack of jobs and financial stress is a mitigating factor in the commission of domestic violence and that participants in his study even report this factor as the "root cause of family violence in the community" (Jones, 2008, p. 115). This study by Jones also had professionals and participants estimating an 80-90% rate of domestic violence among the seven tribes that were studied (Jones, 2008, p. 115) which is a rate much higher than any other individual group reports or that of the general population which has held steady at 25% (Center for Disease Control and prevention , 2010). Another contributing factor to the ongoing instances of domestic violence among Native Americans is family dynamics and tribal beliefs. Many Native American communities have strong beliefs about interfering in the lives of other members. This makes it extremely difficult to report an incident. Victims may also feel a strong sense of loyalty to family, clan or tribal grouping which may make them feel they need to protect the batterer (Jones, 2008, p. 115). Many times this may lead the victim to blame themselves for the abuse as they are given negative beliefs from the community about who is to blame. For the children of this abuse they are affected greatly. They often feel the need to protect the victimized parent. These children become "parentified" and assume the responsibility for the abuse (Jones, 2008, p. 116). Many Native American families do not have strong boundaries. Children are raised at their own pace and when domestic violence occurs they are suddenly forced into the caregiver role that they are unprepared for. The outcomes for the children of this population are PTSD, low self-esteem, depression, anxiety, anger and psychological trauma (Grossman & Lundy, 2007, p. 1042).
Asian families are another culture that makes up the ever growing American landscape. When dealing with this population like others we must take into consideration traditional beliefs and reluctance to report instances of violence to authorities of different cultures. According to Rimonte (1991) during the early social movement to stop domestic violence Asians and other immigrants were not viewed as being affected by domestic violence. "Asian" populations by definition vary in their belief of what constitutes abuse. An example of this would be a Chinese woman who is belittled by her husband in public and whose resources are taken and is locked in her home would not be viewed by her community as being abused whereas a South Asian who has the same things happen to her in private would also not be considered to be abused by her community according to (Midlarsky, Venkataramani-Kothari, & Plante, 2006, p. 282). Other than physical abuse Asian domestic violence concerns itself with financial control, image and much like the Hispanic population a culture that is rooted with rigid sex roles. Chinese traditions are founded in Taoism, Buddhism and Confucianism. Taoism and Buddhism are guides for Chinese spirituality while Confucianism is the tenets of morality and conduct and that teaches women that they are inferior, which is a tradition that has carried on until today. Women are taught to obey a series of men throughout their lives. Their father when they are children, their husbands and finally their sons when they become a widow. (Midlarsky et al., 2006, p. 286). This makes women highly dependent on men. Tradition also calls for women to put the family before themselves at all times. Breaking from this norm or causing the family to lose face results in shaming and being ostracized for these women, the culture ducats that Asians have the face of the "model minority" (Midlarsky et al., 2006, p. 287). This follows along the Confucionistic belief that relationships should be harmonious. This means that culturally a woman should try to keep her husband happy even in he is committing domestic violence against her. From early childhood these women are taught that the greatest shame they could bring to their families is to fail as a spouse so they have a very androcentric (male-centered) view of marriage (Midlarsky et al., 2006, p. 285). Concerning prevalence among this population in a phone survey conducted in Los Angeles, Yick ( 2005) found that 80% of participants reported verbal aggression in their lifetimes. The outcomes for Asian children exposed to domestic violence have not been studied to any degree but we can make the inference that since all other populations that we have looked at have the same outcomes that these children's would mirror the outcomes for other minority cultures and the general population. They would include: PTSD, low self-esteem, depression, anxiety, anger and avoidance.
Having examined these four various cultures the outcomes for children who have witnessed domestic violence from different cultures are the same despite different traditional, cultural, religious and gender beliefs. Much of the literature supports the notion that domestic violence can be attributed to low SES, cultural beliefs, and low educational attainment. With that being stated, there is no discernable evidence for what causes this phenomenon among those who live in a higher socioeconomic strata or the belief that domestic violence is an issue at whose heart is power and control. One explanation for the prevalence of domestic violence continuing throughout generations and across SES may be a theory known as the intergenerational transmission of violence. To determine who will become a domestic violence offender many things must be considered when investigating this social problem they include: culture, religious beliefs, ethnicity and an individual's history of abuse. A phenomenon known as intergenerational transmission of violence is what has become known to describe a person who was exposed to or suffered from some form of violence as a childhood (including domestic violence) and is now a perpetrator themselves. Thomsen, Crouch, May, Gold, Milner and Merrill state that "parental and non-parental DV were significant predictors to adult CPA (Child Physical Abuse) and their effects were similar in magnitude" (p.996, 2005). Along with this criterion (intrafamial violence) a family history of alcohol abuse and a low education level was found by Kantor and Asdigian (1993) to be a determinant in the identity of an offender. If this theory can be proven to be true early interventions for children who are witness to domestic violence will be necessary to prevent them from becoming perpetrators.
A worker does not know how he/she might come in contact with a child who has been exposed to domestic violence including referrals from other agencies. That worker may or may not know if there was violence in the home and what affect that has had on the child. There are no formal assessment tools to detect child witnessing of IPV for children in the home (Myers, 2011). Family physicians are usually the first to identify trauma in a child, and although most CPS workers are aware of the occurrences, more than half do not inquire about IPV and maltreatment (Myers, 2011). Based on the inconclusive research for risk factors for of children who have witnessed or been exposed to violence, improving practice for interview, contracting, investigation, intervention, assessment, and community outreach should focus on increasing protective factors for children. This would include areas from an economic, ecological, and personality factors for the perpetrating parent, the parent victim, and the child. It would also include increasing supports, building positive relationships, educating parents, professionals, and children about exposure to domestic violence.
In concluding that the cause of domestic violence cannot be conclusively known workers that come in contact with children and caregivers who are involved in domestic violence should attempt to improve contracting, interviewing, assessment, investigation, interventions and community outreach. It is important here to remember to include not only the child and non-offending parent but the perpetrating parent as well. The scope of these tasks should revolve around assisting with stressors related to any factors that can be seen as lending themselves to the domestic violence and also asset building for the family. Asset building can include economic assistance, education about domestic violence, educating professionals that the family may be working with and increasing supports the family has.
When initially interviewing a client it is always important to remember to take a not knowing stance and remain objective. It is also important for the worker to be fully aware of his/her feelings, thoughts, and biases toward and about the subject of domestic violence and how this subject may have impacted the worker's own life. According to Crosson-Tower before doing any work it is important to understand internal reactions which would influence external cues (2010). Establishing rapport helps the client to gain trust and fosters open and free communication (Hepworth, Rooney, & Larsen, 2002, p. 46). Another part of interviewing is starting where the client is. This means that the worker should be in tune to what the client's need is that present moment. This also involves using language that children can understand, making sure to avoid blame for all parties and to create a working therapeutic alliance with the family. Goal attainment is another important part of interviewing. As clients attempt to undergo the process of change they must make progress toward goals so that they are not jumping from one issue to another without any resolution (Hepworth et al., 2002, p. 55).
Contracting is another important part of working with a client. Contracts specify goals to be accomplished and the means to accomplish them, clarify the roles of participants and the conditions under which assistance is provided. When formulating a contract it is important to design goals to be accomplished, decide what roles each participant will play, which intervention techniques will be employed, the time frame and length of sessions, means of monitoring progress and housekeeping terms such as beginning date, changing schedules and financial arrangements (Hepworth et al., 2002, p. 348). When contracting with a family system who have been exposed to domestic violence it would be important to pay attention to clarifying the role, getting client's feedback, partializing concerns, supporting taboo areas, and dealing with authority issues (Shulman, 2009). Lastly, the family should contract to agree to create a safety plan and execute that plan.
An important factor to consider when investigating a family who has been involved with domestic violence is resiliency and protective factors. "According to the theory of resilience, protective factors can function in one of four ways: by reducing the impact of a risk, by reducing a negative chain reaction that might have actualized a risk, by developing a person's self-esteem, or by creating opportunities through social reform" (Turner & Lehning, 2007, p. 69). Research has shown that protective factors include age at time of abuse, socioeconomic status, self-esteem, good peer relationships and community support. A good way to assess for family strengths and resiliency would be to use the resiliency quiz (Henderson, n.d.). Investigation should also include looking into the trauma of family members who have been exposed to violence.
When assessing a family with a domestic violence history a complete bio-psychosocial assessment should be done with at least one parent and the child to try to elicit as much information as possible about that client systems particular history (Indian Health Service [IHS], 2006). The assessment tool should cover all areas of the client's life history. This would include information about the client's home life as a child, their current situation, physical health, and mental status. Assessment is done by conducting an interview with the assessment tool. "Assessment refers to gathering relevant information about a problem so that decisions can be made about what to do to solve it" (Kirst-Ashman & Hull Jr., p. 34). The assessment process not only helps to identify current issues but can tell the worker about the client's strengths. Trauma assessments should be careful to notice all symptoms and behaviors that can be the byproduct of witnessing or being a victim of domestic violence.
Treatment goals for families that are involved in domestic violence should include input from all family members. Every family member should have a say on what the goals are to be and how they should be attained. This empowerment through choice and control is important in having a therapeutic alliance. Other goals would be to promote an open discussion of the event or events, to reduce the symptoms and behaviors of witnessing domestic violence, to manage and cope with the emotional responses to the violence, and encourage the positive responses they are already doing (strengths), to work to help the family create a safe stable environment, whatever that might be, and to always stress the importance of involving parents (Groves, 1999).
Improving practice through community outreach would include educating professionals regarding safety is based upon not only what goes on in the house but how agencies must work together to ensure safety (Rivett, 2001). Workers must remember to see this issue through a trauma informed lens and not to retraumatize their clients by giving them the feeling or impression that there is something wrong with their family or referring them to agencies or other workers that are not trauma informed. Workers have to remember that their duty is not only to the family but to the general society at large. Another aspect of community outreach is to educate the public as a whole. Educating both children and adults in schools, workplaces and through public media hopefully would bring about the change necessary to end domestic violence.
On a micro level it is important for all members of a family that are affected by domestic violence to access services, including the offending caregiver. An important aspect to consider when working with a family involved in domestic violence is that we remain neutral. It is not the job of the worker to decide or take sides with behavior we deem to be unacceptable. We do this by maintaining a trauma informed perspective. In order to build on the strengths that the family already has the worker must remember to take a strength based approach and keep their own beliefs and values to the side (Shulman, 2009).
On a micro level using a trauma informed approach. This can be done through trauma focused cognitive behavioral therapy (TF-CBT). Although not every child who witnesses domestic violence will have trauma symptoms that need to be treated, it is something that should be ruled out through assessment. TF-CBT (http://tfcbt.musc.edu/) is an empirically based intervention that works with children who have been exposed to a traumatic event. TF-CBT focuses on all aspects of trauma informed care which include safety, trustworthiness, collaboration, choice, and empowerment. This model has uses different aspects to address the trauma. The first is psychoeducation. The next step is stress management which teaches the child appropriate ways to control their emotions by using thought stopping techniques, controlled breathing, and relaxation. The next step involves the worker teaching the child how to increase emotional awareness. The cognitive coping aspect teaches children about restructuring thoughts, feelings, and behaviors. Next a trauma narrative allows the child to express their thoughts and feelings regarding the traumatic event, and cognitive processing challenges the child's cognitions regarding the event. The last two aspects of TFCBT behavior management and parent child sessions allow the parent to manage the child and allow the parent and the child to interact. These parent child sessions could include both the offending and non offending parent.
For the non-offending caregiver, assertiveness training (Kirst-Ashman & Hull, 2009) can help shift the focus to the self and child, which may eventually lead to her to seek help, going to a shelter, and ending the domestic disputes with her husband. Through empowerment, the non-offending parent can increase their sense of power and control over their life, increase self confidence, and decrease depression (Kirst-Ashman & Hull; Lin et al., 2008). This can be done by assessing strengths, giving feedback, and seeing both positive and negative in life. Teaching assertiveness skills is an intervention that can "improve personal interactions, which in turn builds confidence" (Kirst-Ashman & Hull, p. 452).
On a mezzo level an evidence based intervention that would work with the non-offending primary caretaker and the child to strengthen the relationship between the parent and the child called Child-Parent Psychotherapy (CPP), which is a relationship based model that works with children who are exposed to marital violence and incorporates interactions with the child's mother (Chen & Scannapieco, 2006; Lieberman, VanHorn, & Ippen, 2005). Targets of the intervention include caregivers' and children's maladaptive representations of themselves and each other and interactions and behaviors that interfere with the child's mental health. This improves the parent-child interactions and will empower the parent to work with the child on the trauma. This is based on the idea that a child's sense of attachment emerges from the mother and child relationship. According to attachment theory marital violence can damage a child's "secure base" (Lieberman et al., p. 1242), which serves as a protector in the child's life, rebuilding this relationship can repair the damage and increase the child's sense of security and safety (Lieberman et al.; Eamon, 2001).
At the macro level interventions that could be used include agencies, clients, service providers and society as a whole working together. A community coordinated response such as working with Integrated Domestic Violence courts, educating police departments, Child Protective Services, victims services at community action agencies, schools and batterers groups to help hold offenders accountable. Also stricter laws concerning children such as the violence Against Women Act need to be put into place. There are laws in every state that deal with children's victimization at the hands of a domestic violence perpetrator but there are few laws that speak to the damage concerning children's witnessing domestic violence due to the negative outcomes it has for them.
Domestic violence is a serious health issue that cuts across all cultures in our society. It is assumed by many to be a problem of the poor or people of color. But as the literature has shown the prevalence rates for these populations, although sometimes higher (Native Americans) may be attributed to the lower number of people in their population. Outcomes for all of these children who witness and are victims of domestic violence are the same. The goal as social workers should be early intervention so that the theory of intergenerational transmission of violence and child physical abuse stops with the current generation in all cultures.