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Innovative Approaches to Family Violence

Margot J Schofield
School of Public Health, La Trobe University; Psychotherapy and Counselling Federation of Australia, Melbourne VIC

Rae Walker
School of Public Health, Faculty of Health Sciences, La Trobe University, VIC

Article Text

This Special Issue of the Journal of Family Studies is devoted to the important topic of family violence. In 1996, the World Health Assembly declared violence a major public health priority (World Health Assembly 1996), and in 2002, the World Health Organization (WHO) released the first World Report on Violence and Health (WHO 2002a). The WHO report addresses different types of interpersonal violence including child abuse and neglect, youth violence, intimate partner violence, sexual violence, elder abuse, self-directed violence, and collective violence. Violence occurring within families tends to continue over long periods of time, and the effects are likely to increase with severity and duration. While violence is widely under-reported, best estimates suggest that millions of women globally experience family violence or are living with its consequences (Krug et al 2002). Given the key role of women in caring for children, there are serious flow-on effects on family life and wellbeing, for children in particular.

Violence is defined by the World Health Organization as: The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that results in or has a high likelihood of resulting in injury, death, psychological harm, mal-development or deprivation (WHO 2002a: 4). Public health approaches to violence prevention have increased dramatically since the 1970s, with the number of publications listed in Medline on violence rising by 550% between the 1970s and the 1990s (Krug et al 2002). A comprehensive public health approach to understanding violence locates the individual, and their actions towards self and others, within a set of interpersonal relationships that are in turn located in a community and society. The levels interact to cause and inhibit acts of violence (WHO 2002b). Family violence can be viewed in the same contextualised way.

Figure 1. A typology of violence (WHO 2002a: 5)

The WHO typology of violence is based on a classification of who commits violent acts against whom (eg partner abuse), and through what means (eg physical violence). Typically, we would locate family violence in the shaded cells of the matrix. That is, we would view it as interpersonal violence perpetrated by a family member against a victim who might be a child, partner or older family member. However, if we consider the causes and consequences of family violence we can begin to see links into the self-directed and collective forms of violence depicted in the WHO matrix. In this special issue of the Journal of Family Studies we have focussed first on understanding the experience and impact of family violence, and then consider a range of innovative preventive and therapeutic responses to family violence. We have been interested in the links that can be made to family violence issues from across the typology of violence matrix. Three population groups have been identified at particular risk: children, women and older people.

Violence and children

Violence against children is a source of ongoing concern. Referral of children to statutory child protection services has more than doubled in Australia over the 7 year period from 1999/2000 to 2005/2006 for a wide range of direct forms of violence including neglect, emotional, physical and sexual abuse (Australian Institute of Health and Welfare [AIHW] 2007). Furthermore, large numbers of children are harmed by witnessing violence in the home. In a national survey of young Australians aged 12-20 years in 1998 and 1999, 23% reported witnessing at least one episode of physical violence in the home against their mother or stepmother involving objects being thrown, hitting, or use of a knife or gun (Indermaur 2001). Approximately 10% of young people live in a household in which the ‘male carer hits them and/or their siblings for other than bad behaviour' (Indermaur 2001: 4). This is very concerning since family violence is a strong predictor of a young person's future as a victim or perpetrator of violence (Abrahams & Jewkes 2005).

Despite the potential for under-reporting, reported rates of child sexual abuse are unacceptably high, particularly for girls (Watts & Zimmerman 2002). A review of studies from 20 countries, including ten national representative surveys, showed rates of childhood sexual abuse of 7% to 36% for girls, and 3% to 29% for boys, with most studies reporting 1·5 to 3 times more sexual violence against girls than boys (Finkelhor 1994). Furthermore, children are most at risk of abuse from family members and caretakers (Yama, Tovey & Fogas 1993). If a child is abused by a family member, the abuse is more likely to occur repeatedly and over a longer period of time, than if the abuser is someone outside the family (Anderson et al 1993).

Violence and women

Research on the prevalence of the various forms of violence perpetrated against girls and women highlight the seriousness of violence against women as a public health problem. A nationally representative survey of Australian women (Australian Bureau of Statistics [ABS] 1996) found that 23% of women who had ever been in an intimate relationship had experienced domestic violence and that 42% of currently single women who had been in an intimate relationship in the past had ever experienced domestic violence. Of women aged 51 to 62 years taking part in a longitudinal study in Melbourne, 28% reported having experienced emotional, physical, or sexual domestic violence in their lifetime (Mazza et al 2001). Another Australian study of middle-aged women found that 15.4% reported having ever lived with a violent partner (Loxton et al 2006a; Loxton, Schofield & Hussain 2004, 2006b). The Australian figures compare generally with those gathered in North America, where a representative US survey found that 20% of women had been physically assaulted by intimate partners in their lifetime (Tjaden & Thoennes 2000). A Canadian study found 15% of women currently living in an intimate relationship had experienced domestic violence from their current partner (Johnson 2001).

An insidious aspect of family violence is that different forms of violence often occur together, thus exacerbating the traumatic impact of the experience (Watts & Zimmerman 2002). For example, physically threatening acts are often accompanied by verbal abuse, threats and by sexual violence (American Medical Association on Scientific Affairs 1992). Fifty percent of women who are physically assaulted by their partners are also sexually assaulted (Frieze & Browne 1989). The coexistence of emotional or psychological abuse with physical violence appears to be even higher.

Violence and older people

There has been an increasing awareness over the last two decades of elder abuse as a serious social problem, with harmful health effects for victims (National Center on Elder Abuse [NCEA] 1998). The comprehensive National Elder Abuse Incidence Study (NEAIS) studied seven types of elder abuse among non-institutionalised elderly in the US (physical abuse, sexual abuse, emotional or psychological abuse, financial or material exploitation, abandonment, neglect, and self-neglect) and estimated an incidence of abuse or neglect in 1996 of nearly half a million older people in the US, with less than 20% of cases reported (NCEA 1998). Of substantiated cases of abuse, physical abuse was found in 62% of cases, abandonment in 56%, emotional/psychological abuse in 54%, financial/material abuse in 45% and neglect in 41%. Relatively little is known about the characteristics of unreported abuse.

In Australia, it has been estimated that approximately 4% of older Australians experience elder abuse, with psychological abuse then physical abuse thought to be most common (Kurrle et al 1997). The Australian Longitudinal Study on Women's Health, known as Women's Health Australia (WHA), estimated that 1-6% of women aged 70-75 experienced various forms of abuse (Schofield & Mishra 2003). For instance, 6% of women reported having been verbally abuse (eg called names, put down), 4% reported having their things taken without their agreement, 3% reported being forced to do things they did not want to do, 2% that someone close to them had tried to hurt or harm them recently, 1% that they had been pushed, grabbed, shoved, kicked, or hit, and been forced to take part in unwanted sexual activity within the last year. US data suggest that the prevalence (or reporting) of elder abuse is rising at a disturbing rate (NCEA 1998), although little is known about trends in Australia, and no current research reports were located for this special issue.

Health effects of family violence

Family violence is considered a serious public health issue because research has demonstrated a consistent association worldwide between violence and a wide range of health problems. A considerable body of evidence points to the long-term harmful effects of child abuse and neglect (Beautrais, Joyce & Mulder 1997; Beitchman et al 1992). Children witnessing violence have also demonstrated significant serious long-term harmful effects (eg Abrahams & Jewkes 2005; Nicholas & Rasmussen 2006).

The strongest body of research relates to the health effects of partner violence against women. Partner violence has been related to poorer general health (Campbell et al 2002; Coker et al 2000), increased chronic health problems (Lown & Vega 2001; Tolman & Rosen 2001), increased periods of sick leave (Hensing & Alexanderson 2000), an increased number of symptoms and diagnoses (McNutt et al 2002), and reporting of more unexplained symptoms (Marais et al 1999). Women who have experienced violence, whether in childhood or adult life, have increased rates of depression and anxiety, stress related syndromes, pain syndromes, phobias, chemical dependency, substance use, suicidality, somatic and medical symptoms, negative health behaviours, poor subjective health and changes to health service utilization (Campbell et al 2002; Coker et al 2000; Golding, Cooper & George 1997; Loxton et al 2004, 2006a, 2006b).

Studies of the impact of elder abuse similarly indicate a positive association between the experience of abuse among older women, and higher rates of self reported physical and mental ill-health (Fisher & Regan 2006; Schofield & Mishra 2004). If the health consequences of all types of violence are added together the population level effects are huge.

To establish a snapshot of the health consequences of violence in the Victorian community, VicHealth commissioned a study of the burden of disease caused by intimate partner violence (VicHealth 2004). Intimate partner violence was found to contribute 9% of the burden of disease in Victorian women in the 15-44 year age group, more than any other single risk factor. The health consequences include depression (33%); anxiety (26%), suicide (13%), tobacco use (10%), illicit drug use (6%) and alcohol use (6%) (VicHealth 2004).

Overview of Special Issue

This Special Issue has been organised into three sections: understanding the experience and impact of family violence, systemic and government responses to family violence, and therapeutic responses to family violence.

Understanding the experience and impact of family violence

This section contains four papers exploring different perspectives on the experience of family violence to fill in gaps in existing evidence. Taft, Hoang and Small undertake the first systematic literature review of intimate partner violence in the Vietnamese Australian community and conclude that Vietnamese victims and perpetrators of family violence are similar to those in other populations especially in regard to the socio-economic determinants of family violence and their consequences. However, immigration and refugee status have conferred particular stressors on this community in Australia, and Vietnamese Australian women may have particular difficulties in accessing appropriate intervention services. This review is complemented by Lewis, Maruia and Walker´s study of violence against women in Papua New Guinea which provides another cultural insight into the issue of domestic violence experienced by women in South-East Asia.

McNamara presents a unique in-depth insight into the consequences of a domestic homicide on a group of the victim's friends. She traces the long-term effects on the friend's relationships with their partners and children, and on the partners and the children themselves. Kielpikowski and Pryor explore the little-researched area of the relationship between silent (unresolved) conflict between parents and the potential for psychological harm to their children, using qualitative interviews. While conflict per se is not necessarily defined as violence, a growing body of research shows that it is often associated with both physical and psychological forms of violence, or at least the threat of violence. This paper is innovative in exploring the experience of silent conflict from the parents' perspective, and contrasts these findings with other research on children's perspectives. It highlights the importance of understanding subjective experience when trying to elucidate the impact of violence.

Systemic and government responses to family violence

This section contains eight papers each of which deals with systemic responses to family violence. Humphreys unpacks some of the difficult issues in the relationship between the family violence and child protection service systems. Cripps and McGlade address the issue of appropriate responses to family violence and sexual abuse in Indigenous communities. They examine the Community Holistic Circle Healing process developed by the community of Hollow Water, Canada, which has been identified as an example of appropriate practice of dealing with family violence in Indigenous communities. Their paper examines the contextualised program critically and asks if it can realistically be transferred into the Australian context.

The next four papers by Moloney, Bala, Kaspiew and Shea Hart and Bagshaw explore different aspects of the Australian legal institutions relevant to family violence. Moloney discusses supports for judicial decision-making in cases involving family violence. Bala discusses changing social attitudes and approaches taken in the justice system to allegations of family violence. Kaspiew delves more deeply into the changing family law frameworks and the contemporary efforts to make it more responsive and effective in dealing with allegations of family violence. Shea Hart and Bagshaw report on an in-depth discourse analysis of 20 First Instance unpublished judgments, in cases involving allegations of family violence, derived from one registry of the Family Court of Australia. They conclude, as do others, that the Family Court is not good at dealing with the effects of family violence on children.

Whitzman and Castelino consider family violence prevention at a community level, undertaken through local government, and the ways local government is influenced by policies and programs at the state and federal levels. Finally, Vincent and Eveline report a study of the representation of gendered power relations in two major policy documents important in the family violence field.

Therapeutic responses to family violence

All four papers in the Therapeutic Responses section address serious, difficult family violence issues and under-researched areas. Bunston describes an innovative group therapeutic program for infants, children and mothers affected by family violence. The program is informed by recent neuroscience research that highlights the highly detrimental effects of early and sustained relational trauma, and it utilises research evidence for effective ways to repair such damage. In particular, it highlights the importance of infant-led and child-led therapeutic play activities, and the involvement of mothers/carers in the treatment program.

Frederico et al present sobering data on the impact of serious abuse and neglect on children and young people, through an analysis of referral and assessment data for those referred to the Take-Two therapeutic intervention program in Victoria. This provides a unique insight into the depth and multitude of issues facing these young people. Thornton et al also present an evidence-based innovative program to address another very difficult area of practice - the treatment of intra-familial adolescent sex offenders. They provide an excellent review of the literature, and their evaluation highlights key implications for future practice. For instance, improvements in family functioning were more likely when at least one parent engaged in the treatment program. The final paper in this section describes a promising model for training health professionals to understand and intervene with women experiencing intimate partner violence (Hegarty et al). Hegarty and colleagues outline the Stages of Change model, successfully used in many areas of health behaviour change, and explores its potential to improve the practice of health professionals among this group.

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