Articles.

  This article addresses the following questions: (a) How common is child abuse among domestically violent families? (b) Are there specific patterns of child abuse among domestically violent families? (c) What may explain occurrences of child abuse in domestically violent families? (d) How might domestic violence affect treatment forchild abuse ? We review research on child abuse in the context of domestic violence. We discuss implications of this research for service-delivery programs for domestically violent families. [PUBLICATION ABSTRACT] 

**Headnote**  This article addresses the following questions: (a) How common is child abuse among domestically violent families? (b) Are there specific patterns of child abuse among domestically violent families? (c) What may explain occurrences of child abuse in domestically violent families? (d) How might domestic violence affect treatment forchild abuse ? We review research on <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse in the context of domestic violence. We discuss implications of this research for service-delivery programs for domestically violent families. Domestic violence (defined here as violence against a current or former intimate partner with whom the abuser shares or has shared a domicile) is now recognized by many as a worldwide problem that dramatically affects the health and well-being of those exposed to it. Although women may be the most obvious victims of domestic violence, their <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children are victims as well. For example, <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children exposed to domestic violence are at risk for a variety of adjustment difficulties. These include aggressive and oppositional behavior, anxiety and depressive symptoms, social problems and cognitive difficulties (see Jouriles, Norwood, McDonald, & Peters, 2001; Wolfe, Crooks, Lee, McIntyre-Smith, & Jaffe, 2003, for reviews). In addition, <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children living in families characterized by domestic violence are at increased risk for physical <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuse and other forms of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child maltreatment (Appel & Holden, 1998; Edleson, 1999). The adjustment difficulties of physically abused <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children are similar to those of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children exposed to domestic violence (Kolko, 2002), and there is some evidence that the problems experienced by <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children in domestically violent families are due, in part, to co-occurring <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse (Jouriles, Barling, & O'Leary, 1987; Mahoney, Donnelly, Boxer, & Lewis, 2003). Unfortunately, despite widespread acknowledgment of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse in many domestically violent families, there has been surprisingly little application of this knowledge in service-delivery programs targeting such families. This article reviews the scientific literature on <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse that occurs within families identified as domestically violent. We attempt to provide science-informed answers to important practical questions: How common is <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse among domestically violent families? Are specific patterns of co-occurrence (that is, are mothers, fathers, or both parents abusive toward their <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children within domestically violent homes) most likely? What may explain occurrences of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse in domestically violent families? How might domestic violence affect treatment for <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse ? Based on the scientific literature, we offer suggestions for consideration in the assessment and treatment of families seeking services for domestic violence. At the outset, it is important to acknowledge that the term "<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse " is broad, encompassing a wide range of acts and omissions. For example, professional organizations, policymakers, researchers, clinicians, law enforcement personnel, and <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child welfare agencies refer to specific categories or types of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child maltreatment (e.g., physical<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuse, psychological or emotional <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">maltreatment , neglect, and sexual <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuse ). Moreover, these categories often are further divided into subcategories; neglect, for example, is commonly defined more specifically as physical, medical, or educational neglect. Although this illustrates the conceptual breadth of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child maltreatment, most research on <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse within domestically violent families focuses specifically on physical <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse , commonly defined by acts such as "hitting with a hand, stick, strap, or other object; punching; kicking; shaking; throwing; burning; stabbing; or choking" (Sedlak & Broadhurst, 1996, pp. 2-10) that harm or significantly endanger a <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child. Thus, in summarizing the research literature on <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse in domestically violent families, we restrict our use of the term "<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse " to physical <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse. It also is important to acknowledge that there is debate about whether <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children witnessing domestic violence should itself be considered a form of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child maltreatment. Exposing <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children to domestic violence, especially to frequent or severe domestic violence, has been conceptualized by some as a form of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child psychological/emotional<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">maltreatment (e.g., Graham-Bermann, 1998; Sedlak & Broadhurst, 1996), and it has been defined as a crime in certain states (see Graham-Bermann, 2002, for specific examples). As indicated earlier, <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children in families characterized by domestic violence are at increased risk for adjustment difficulties (Jouriles et al., 2001; Wolfe et al., 2003), and it is difficult to imagine how repeated exposure to domestic violence could be benign. On the other hand, many common parent behaviors are known to have deleterious consequences for <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children (e.g., alcohol<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuse, smoking), and it is difficult to discern where the line should be drawn between what is irresponsible, inappropriate, or just "bad for <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children " and what is abusive. The admittedly narrow focus in this article on physical<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse sidesteps the thorny philosophical, moral, and legal issues about what constitutes "<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuse ." However, it renders the scope of discussion in this article manageable. <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span style="background-attachment: initial !important; background-clip: initial !important; background-color: initial !important; background-image: none !important; background-origin: initial !important; display: block; margin-bottom: 17px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> HOW COMMON IS <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">CHILD ABUSE AMONG DOMESTICALLY VIOLENT FAMILIES? Definitions of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse, methods for collecting data on parental aggression toward <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children , and conceptualizations of co-occurrence are key factors that complicate answering the question: How common is <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse among domestically violent families? We do not provide an exhaustive review and discussion of these complicating factors; rather, we offer examples that illustrate the issues and structure the following review of the scientific research. Definitions and Methods Physical <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse is often defined differently across studies. As might be expected, broad definitions of physical<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse (e.g., those that include pushes, slaps, and spankings) yield relatively high prevalence rates, whereas narrow definitions yield lower rates (O'Keefe, 1995; Slep & O'Leary, 2005). In this review, we address the question, "How common is <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse among domestically violent families?" separately for studies that use broader and narrower definitions of physical <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse. Methods for assessing parental aggression toward <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children or <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse (e.g., measures, sources of data) also influence prevalence estimates, with <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child and parent reports during interviews or on questionnaire measures typically yielding higher rates of aggression/<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuse than official records (Kolko, 2002). Also, family members themselves often provide discrepant reports of parental physical aggression toward <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children (Jouriles, Mehta, McDonald, & Francis, 1997). Thus, prevalence rates are likely to be higher if one considers multiple family members' reports rather than the report of any single family member. Consequently, in addressing the prevalence question, we highlight the methods used by investigators to make <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse determinations. The reference period, or the time frame for which <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuse is assessed, ranges greatly across studies. For example, some investigators have considered "childhood" as the reference period. That is, adult participants are asked to report retrospectively on whether they witnessed domestic violence or experienced <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse at some point during their childhood; a report of both forms of violence by an individual is conceptualized to indicate cooccurring domestic violence and <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse. More commonly, though, adult participants are asked whether they have engaged in specific behaviors indicative of domestic violence and <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse during a shorter, more recent time period (e.g., within the past year). In the present review, we focus on families marked by domestic violence and physical <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse that occurred within the year prior to the assessment. <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span style="background-attachment: initial !important; background-clip: initial !important; background-color: initial !important; background-image: none !important; background-origin: initial !important; display: block; margin-bottom: 17px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;">Conceptualizations of Co-Occurrence Co-occurrence can be conceptualized as a within-individual phenomenon (e.g., a husband <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuses his wife as well as his <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children ), one that occurs across individuals within the same family (e.g., a husband <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuses his wife and the wife <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuses her <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children ), or both (e.g., a husband <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuses his wife and both the husband and wife <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuse the<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children ). In this review, we consider both within- and across-individual co-occurrence of domestic violence and<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse, and we clearly articulate the perpetrator of the <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse when these data are available. <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span style="display: block; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="background-attachment: initial !important; background-clip: initial !important; background-color: initial !important; background-image: none !important; background-origin: initial !important; display: block; margin-bottom: 17px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> Article Search We used a variety of methods to search for empirical articles that present an estimate of the prevalence of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse within domestically violent families or allowed us to derive such an estimate. We began with the studies summarized in Appel and Holden's (1998) review of this topic. To add to their list, we conducted keyword searches for articles published since 1998. Articles from the following electronic databases were included: PsycINFO, MEDLINE, the Psychology and Behavioral Sciences Collection, and the Sociological Collection. Keywords used in the search included <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse, domestic violence, violence, family violence, co-occurrence, and prevalence. We also conducted keyword and author searches more generally, using Google, the MINCAVA (the University of Minnesota School of Social Work electronic clearinghouse) Web site, the U.S. Department of Health and Human Services Web site, and University of New Hampshire Family Research Laboratory Web site. We reviewed reference sections of the collected articles to identify additional articles. We also conducted a review of literature on <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child witnesses of domestic violence because rates of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse are sometimes reported in these articles. To address the question-How Common Is <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">Child Abuse in the Context of Domestic Violence?-we focused on studies in which it was possible to discern the number of families in which domestic violence had occurred and, within those families, the number in which physical <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse had occurred. We also focused on studies in which <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse was unambiguously defined (e.g., specific acts were listed as part of the definition) and was measured within a 1-year time frame of the domestic violence. We excluded studies in which the primary sample was identified on the basis of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse rather than domestic violence because such studies address the different but related question of domestic violence in the context of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse rather than the topic of this review, <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse in the context of domestic violence. Tables 1 and 2 summarize these studies. Table 1 is limited to those in which a more restricted definition of physical <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse (often referred to as severe parental aggression) is used. Although there is still variability in the definitions across these studies, most defined<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse as a variant of the following: " hit him or her on some other part of the body besides the bottom with a hard object; threw or knocked down; hit him or her with a fist or kicked hard; beat up, that is hit him or her over and over as hard as parent could; grabbed around the neck and choked; and threatened with a knife or gun " (Mahoney et al., 2003, p. 7). Studies in which spankings, slaps, and pushes are part of the definition of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse are excluded from Table 1. Table 2 includes studies with a broader, more inclusive definition (e.g., any parental physical aggression toward <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children including spankings, slaps, and pushes); however, aside from the definition, Table 2 studies are similar to those in Table 1. Studies in Table 1 are listed in descending order of the prevalence of physical <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse in the context of domestic violence. Perhaps the most striking feature of Table 1 is the broad range of estimates of physical <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse in domestically violent families-18% to 67%. Reasons for this breadth are not immediately apparent, but characteristics of the studies themselves, in particular the samples employed, reveal several possible explanations. First, a close inspection of Table 1 suggests that <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse may be less prevalent in domestically violent families identified in community surveys as opposed to domestically violent families in which women are seeking refuge from violence at a shelter or the family is seeking other clinical services. This is an important observation, particularly for clinicians working with domestically violent families. It also seems important for understanding what differences may exist between help-seeking and non-help-seeking families that help explain the variability in the estimates in Table 1. For example, it is now well-documented that the frequency and form of domestic violence in shelter-seeking families is drastically different than that in "violent" community families identified in survey research (Johnson, 1995). Thus, to the extent that frequency and severity of domestic violence relates positively to risk for <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse (and it does; see discussion below), one might expect higher rates of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse in samples characterized by frequent and severe domestic violence (such as shelter-seeking families). It is possible that variability in definitions of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse also accounts for variability in <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse rates across studies in Table 1. For example, in the O'Keefe (1995) study, <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse was defined by the occurrence of one of the following acts directed against the <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child in the year prior to the assessment: hitting with an object (e.g., a belt or paddle), kicking, biting, punching, burning, beating up, choking, and attacking with a gun or knife. However, many people object to "hitting with an object" as an indicator of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuse. When O'Keefe recalculated <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse rates without this item, 35% of the <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children were considered abused (as opposed to the 67% reported in Table 1). In addition to the O'Keefe study, four other studies in Table 1 (Giles-Sims, 1985; Mahoney et al., 2003; Straus & Gelles, 1988; Straus, Gelles, & Steinmetz, 1980) included "hitting with an object" or "hit or tried to hit with something" as part of their definition of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse. Slep and O'Leary (2005) included a variant of this item: "hit some other part of the body other than the bottom with something like a belt, hairbrush, a stick or some other hard object." McCloskey (2001) and Jouriles, Spiller, Stephens, McDonald, and Swank (2000) did not include such an item as part of their definition. Also related to the point about differences in help-seeking and non-help-seeking families, we inspected demographic characteristics of the participants in the studies listed in Table 1. There was variability across studies in family income; for example, Jouriles et al. (2000) reported a median annual family income of $15,980, whereas Slep and O'Leary (2005) reported a median annual family income of $74,500. There was also variability across samples in ethnic and racial diversity. However, it is not clear if these demographic characteristics related to rates of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse within domestically violent families (across studies). For example, the two studies reporting the highest rates of parental <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse (67%; Mahoney et al., 2003; O'Keefe, 1995) consisted of very different samples. Specifically, in the Mahoney et al. study, the sample was 90% White and the modal family income was in the $36,000-$60,000 range. In the O'Keefe study, the sample was 42% White and the modal family came from "low socioeconomic backgrounds." In short, while it is impossible to make systematic comparisons across the studies listed in Table 1 on sample demographic characteristics, it does not appear that racial/ethnic diversity or income level account for a large portion of the variability of the estimates of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse within these studies. Table 2 illustrates how rates of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse are higher when more inclusive definitions of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse are applied. In each of these studies, slaps and spanks were part of the definition of physical <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse. There, again, is a range in estimates of the rate of parental <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse (40% to 97%). However, the rates are all very high, with most studies exceeding 75%. It is also important to notice, in both Tables 1 and 2, that when data were reported in a manner so that the perpetrator of the <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse could be identified, rates of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse are approximately equal for mothers and fathers. In addition to the information in the tables, several other findings are worth highlighting. First, a number of investigators have directly compared rates of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse across domestically violent and nonviolent families. Although the majority found higher rates of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse (almost twice as high or higher) within domestically violent families (Mahoney et al., 2003; Ross, 1996; Rumm, Cummings, Krauss, Bell, & Rivera, 2000; Slep & O'Leary, 2005; Straus et al., 1980), there were also studies that found no differences (Eckenrode et al., 2000; McDonald, Jouriles, Norwood, Ware, & Ezell, 2000). Second, when domestic violence is more frequent, parental aggression toward<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children is also more frequent (Jouriles et al., 1987; Jouriles & LeCompte, 1991; Ross, 1996). That is, there is a positive correlation between the frequency of domestic violence and parental aggression toward <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children. Third, there is some evidence that boys in domestically violent families are at a higher risk for parental aggression than girls (Jouriles & Lecompte, 1991; Jouriles & Norwood, 1995; Ross, 1996; Straus et al., 1980). <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span style="display: block; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="background-attachment: initial !important; background-clip: initial !important; background-color: initial !important; background-image: none !important; background-origin: initial !important; display: block; margin-bottom: 17px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> ARE SPECIFIC PATTERNS OF CO-OCCURRENCE MOST LIKELY? In their review of the literature on co-occurring domestic violence and <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse, Appel and Holden (1998) proposed different patterns of co-occurrence, four of which are depicted in Figure 1. These patterns are descriptive, indicating who is abusing whom. We are aware of only two studies designed to compare the relative prevalence of these different patterns of co-occurrence (Mahoney et al., 2003; Slep & O'Leary, 2005). In both studies, only a small percentage of the co-occurrence cases fit the sole perpetrator model in which one parent directs physical aggression toward the partner and the <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child (<18%). Similarly, only a small proportion fit the sequential perpetrator model in which one parent engages in domestic violence while the other parent targets the <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child (<18%). The dual perpetrator model fit 21.2% of the families in the Mahoney et al. (2003) study but none of the families in the Slep and O'Leary study. The marital violence model was the most common by far in both studies characterizing over 50% of the domestically violent families in which <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse also occurred. That is, it appears most common for both spouses to engage in domestic violence and for one or both to use severe aggression toward the <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child. It is also useful to note that in the marital violence model, mothers were about as likely as fathers to use severe physical aggression toward the <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child. Although the patterns were similar across studies, caution is encouraged in interpreting these results; there are only two studies, and each included a small number of domestically violent families. <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span style="display: block; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="background-attachment: initial !important; background-clip: initial !important; background-color: initial !important; background-image: none !important; background-origin: initial !important; display: block; margin-bottom: 17px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> WHAT MAY EXPLAIN OCCURRENCES OF <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">CHILD ABUSE IN DOMESTICALLY VIOLENT FAMILIES? Several plausible hypotheses have been offered to explain why <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse is so prevalent within domestically violent families. One explanation is that certain individuals have a propensity for aggressive behavior, and because of this propensity anyone who spends time with these individuals (partners and <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children ) is at increased risk for becoming a victim of violence (McCloskey, 2001). This "aggressive individual" explanation, of course, applies to co-occurring domestic violence and <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse perpetrated by the same individual. This explanation is rooted in general theories of crime and deviance (e.g., Donovan & Jessor, 1985; Gottfredson & Hirschi, 1990), which suggest that aggressive individuals do not tend to specialize in particular forms of aggression (domestic violence vs. <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse ). Rather, they simply tend to be aggressive and do not differentiate among targets. This explanation typically invokes person-based variables to explain why these individuals have a propensity for aggressive behavior. Examples of such variables include personality characteristics (e.g., impulsivity, hostility), biological characteristics (e.g., physiological reactivity to stress), psychological functioning (e.g., depression, substance dependence), and historical risk factors that set the stage for later aggression (e.g., exposure to violence in family of origin). Consistent with this hypothesis, many of the person-based variables that explain why individuals have a propensity for aggressive behavior are correlates of both domestic violence and <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse (Slep & O'Leary, 2001), and certain person-based variables (e.g., depression, substance dependence) have been found to be at higher levels in families marked by both wife <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuse and <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse, compared to families marked by only one of these forms of<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuse (e.g., O'Keefe, 1995; Tajima, 2004). An alternative explanation is that aggressive behavior, including both partner and <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse, is triggered by stressful events or a series of events or circumstances that cause stress. Patterson (1982), for example, hypothesized that the accumulation of family crises and stressful circumstances leads to higher levels of negativity/aggression across family dyads (parent-<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child, parent-parent), particularly among family members for whom interpersonal aggression had been reinforced in the past. Consistent with this hypothesis, indicators of stress, such as economic and parenting stress, are correlates of both domestic violence and <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse (Slep & O'Leary, 2001). In addition, certain types of family stressors (e.g., financial stress, parenting stress, <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child behavior problems) appear to potentiate the relation between domestic violence and <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse (Jouriles & Norwood, 1995; Margolin & Gordis, 2003). Another possible explanation is that one type of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuse either causes or sets the stage for the other. This explanation is most often presented as a variant of the spillover hypothesis, wherein domestic violence, most often defined as husband-to-wife aggression, spills over and increases the likelihood of parental violence, usually defined as mother-to-<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child aggression. Several conceptualizations of this hypothesis have been offered in the literature. One suggests that the negative affect and arousal generated by husband-to-wife violence spills over into parent-<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child interaction, increasing the likelihood of parental attacks on the <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children (Margolin & Gordis, 2003). Another conceptualization is that domestic violence prompts mothers to purposefully direct aggression toward their<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children (for misbehaving) in an effort to avoid angering their violent husbands (e.g., a mother becomes overbearing to keep her <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children quiet; McKay, 1994). That is, the aggression toward the <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children might actually be intended to protect them and/or the mother from a more severe attack by the husband (Margolin & Gordis, 2003). It is quite possible, even probable, that the processes hypothesized above operate simultaneously. That is, <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse in domestically violent families is not likely to be explained by any single process. Despite considerable speculation about what explains the increased prevalence of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse in domestically violent families, we are still far from making strong, empirically supportable conclusions. HOW MIGHT DOMESTIC VIOLENCE AFFECT TREATMENT FOR <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">CHILD ABUSE ? Although there are a number of studies on <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse prevention and the treatment of abusing parents, very little is available on the treatment/prevention of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse in the context of domestic violence. A notable exception is the work of Eckenrode, Olds, and colleagues on their home visitation program. Specifically, certain home visitation interventions have been found to reduce the likelihood of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child maltreatment. These interventions typically involve regular visits by a professional (e.g., nurse) to a family's home over a period of months/years. Home visitors typically strive to form a positive relationship with family members (supporting their strengths), teach parents about <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child development, facilitate appropriate and stimulating parent-<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child interaction, and promote positive family health. In a secondary analysis of data from a well-known randomized trial targeting families at risk for <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child maltreatment (details of the intervention and the study sample can be found in Olds et al., 1997; Olds, Henderson, Chamberlin, & Tatelbaum, 1986), the investigators found that the likelihood of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child maltreatment was reduced for families receiving the home visitation program. Impressively, this reduction occurred over a 15-year, postintervention followup period. However, for families with more than 28 incidents of domestic violence over the 15-year follow-up period, the home visitation program did not reduce the likelihood of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child maltreatment (Eckenrode et al., 2000). Although it is not clear precisely why this particular intervention was less effective for domestically violent families, Eckenrode and colleagues speculated that domestic violence is associated with compromised parenting, an interpretation consistent with the spillover hypothesis as well as with research on the link between domestic violence and parenting (e.g., Levendosky & Graham-Bermann, 2001). In short, this particular finding cautions against simply presuming that empirically supported <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child maltreatment programs work equally well for domestically violent and nonviolent families. A second exception is the work of Jouriles, McDonald, and colleagues (Jouriles & McDonald et al., 2001; McDonald, Jouriles, & Skopp, 2006). These investigators developed and evaluated Project SUPPORT, an intervention designed for families departing from women's shelters with at least one <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child exhibiting clinical levels of conduct problems. Although the goal of the intervention was to reduce conduct problems among the <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children, a key method for accomplishing this was to reduce parent-<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child aggression. The intervention included two core components: (a) providing instrumental and emotional support to mothers after shelter departure, and (b) teaching mothers to implement a set of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child management and nurturing skills. Services were initiated shortly after shelter departure, were home-based, and lasted up to 8 months. The results of the initial evaluation of Project SUPPORT were quite promising (Jouriles & McDonald et al., 2001; McDonald et al., 2006). Eight months after completion of treatment (16 months after the families had departed the shelter), results indicated that mothers learned to properly apply<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child management techniques more rapidly in the Project SUPPORT intervention condition than in the existing services comparison condition. In addition, in a follow-up conducted 2 years after treatment, mothers in the Project SUPPORT condition were less likely than mothers in the comparison condition to use aggressive <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child management strategies. In sum, the secondary analysis of Olds's home visitation program indicates that domestic violence may limit the effectiveness of some interventions that are otherwise effective in preventing <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse ; however, the evaluation of Project SUPPORT suggests that <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse can be addressed in the context of domestic violence. There are many differences between these two evaluation projects, making it impossible to pinpoint the reasons for these different findings. For example, Olds's home visitation program was designed for mothers of infants and very young<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children who were at risk for <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child maltreatment (but not necessarily at risk because of domestic violence), and the intervention began prior to the birth of the <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child. Project SUPPORT was designed for mothers and <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children who sought refuge at a shelter for domestic violence, and it targeted families of preschool and elementary school-aged<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children exhibiting clinical levels of conduct problems. Both programs averaged between 20 and 35 home visits, but Olds's home visitation services were spread out over 2.5 years, whereas the Project SUPPORT services were condensed into an 8-month period. It seems reasonable to conclude, though, that domestic violence may be a context that requires focused and intensive services for <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse. <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span style="display: block; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="background-attachment: initial !important; background-clip: initial !important; background-color: initial !important; background-image: none !important; background-origin: initial !important; display: block; margin-bottom: 17px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> CLINICAL IMPLICATIONS FOR THE ASSESSMENT OF <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">CHILD ABUSE The research reviewed above suggests that <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse is prevalent within domestically violent families. In fact, a case could be made that, more often than not, there has been an incident of severe caregiver aggression directed toward a <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child (within a year of the domestic violence) in service/refuge-seeking domestically violent families. Although the research is sparse, it appears that the most typical pattern of co-occurring domestic violence and <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse is that both parents aggress against each other, and one or both aggress against the <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child. This points to the need to assess for parental aggression toward <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children (perpetrated by both men and women) when domestic violence is identified, particularly from the perspective of protecting at-risk <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children. This suggestion for assessment should not be confused with investigating for <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse ; however, from the perspective of protecting at-risk <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children, questions about parental aggression toward <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children should be asked and appropriate referrals should be made when indicated. For clinicians, though, the decision to assess for parental aggression toward <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children in a domestically violent family raises a number of ethical, legal, and clinical considerations. The possibility of uncovering <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuse that necessitates a report to <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">Children 's Protective Services (CPS) may prompt concerns about subjecting a domestic violence victim or an offender newly engaged in treatment to an investigation typically perceived by parents as intrusive rather than helpful (Bragg, 2003). In addition, reports to CPS about families who are already receiving clinical services often do not lead to service recommendations that differ from those in which the family is already engaged. Clinicians are also likely to have concerns about damaging the therapeutic alliance, increasing the family's resistance to treatment and the risk for dropout, and subjecting domestic violence victims to additional coercion by failing to respect their autonomy in making important family decisions (Beeman, Hagemeister, & Edleson, 1999; Lewis, 2003). Clinicians must also be sensitive to practical realities when confronting domestically violent families. Victims of domestic violence may have real (and realistic) fears about their <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children being taken away either by an agency (e.g., CPS, for failure to protect) or by their partners. Such fears are sometimes encouraged and even exacerbated by domestically violent partners who threaten to "take" or abduct the <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children or see that the victim loses custody of the <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children. Family members may also be reasonably fearful about their own physical safety if they disclose<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse. Assessments may prompt questions among family members ("What did you tell them about. . . . ?"), which may lead to additional incidents of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuse. Financial concerns also govern disclosures of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse. For example, the fear of unwanted family separation that may engender financial hardships for the family, such as the father's removal from the home or arrest and detention, likely reduces disclosure of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse. Before assessing for parental aggression toward <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children, it is important to consider a number of details. These include the timing of assessments (e.g., toward the end of an initial assessment session), measures to be used (see Friedrich, Olafson, & Connelly, 2004; Milner, 1995, for descriptions of measures), how the assessments are to be conducted (e.g., individual interviews with family members), the frequency in which such assessments will be conducted over time, and safety planning for family members. It is also important to consider how the definition of<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuse used during the assessment may differ from definitions used in mandated reporting laws. Such differences are important to recognize, and knowledge about such differences will minimize confusion and ensure adherence to the law when potentially reportable <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">maltreatment is detected. Families should be informed of the limits of confidentiality, including legal requirements to report suspicions of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse, during the informed consent process. In addition, the clinical relevance and importance of such assessments should be made explicit to families. Gathering information about parental aggression toward <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children without a client-focused, clear, and cogent rationale is likely to be met with resistance. <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span style="display: block; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="background-attachment: initial !important; background-clip: initial !important; background-color: initial !important; background-image: none !important; background-origin: initial !important; display: block; margin-bottom: 17px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> CLINICAL IMPLICATIONS FOR THE TREATMENT OF <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">CHILD ABUSE Evidence is sparse, limited in scope, and mixed on the efficacy of treatment or prevention efforts for <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse in the context of domestic violence. In theory, treatment for <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse might be more effective following treatment for domestic violence, especially given certain hypotheses for what explains the increased prevalence of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse in domestically violent families (e.g., spillover hypothesis). However, given the very limited effectiveness of most domestic violence interventions (see meta-analysis by Babcock, Green, & Robie, 2004) and the immediate risks potentially faced by <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children in these families, it is, of course, not appropriate to simply wait for the domestic violence to stop before beginning an intervention to protect <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children from <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">maltreatment. We acknowledge clear answers about how to proceed on this topic are unavailable, but we offer several suggestions. First, as noted above, it seems reasonable to conclude that domestic violence may interfere with <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse prevention/intervention efforts, but it does not make <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse impossible to address. Although there is not a body of research explicitly evaluating treatment for <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse in domestically violent families, characteristics of programs deemed effective in related treatment research (e.g., Jouriles & McDonald et al., 2001) suggest that providing home-based intervention services and providing mothers who are victims of domestic violence with comprehensive training in <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child nurturing and <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child management skills can reduce risk for <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse in domestically violent families. Such programs might be used as a point of departure for efforts to treat <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse within the context of domestic violence. Second, as reviewed earlier, several person-based and environmental variables have been identified as risk factors for both domestic violence and <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse. Accordingly, treatment strategies targeting those risk factors may help reduce the risk for both <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse and domestic violence. For example, depression or substance <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuse (risk factors for both forms of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuse ) can be evaluated and intervened upon if they are associated with violence in a given family. The simultaneous presence of a broad range of clinical problems-in addition to those of domestic violence and <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse -complicates treatment planning and delivery considerably. <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"><span style="display: block; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="background-attachment: initial !important; background-clip: initial !important; background-color: initial !important; background-image: none !important; background-origin: initial !important; display: block; margin-bottom: 17px; margin-left: 0px; margin-right: 0px; margin-top: 0px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> CONCLUSIONS <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">Children in domestically violent families are at substantially elevated risk for physical <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse compared with<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children in homes without domestic violence. It appears that the most typical pattern of co-occurring <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuse is that both parents aggress against each other and one or both aggress against the <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child. Assessing for <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse in domestically violent families is prudent both from the perspective of protecting <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">children and from the perspective of informing treatment planning. Such assessment is best conducted in the context of welldelineated policies that will help the clinician and clients avoid some of the potential pitfalls of incorporating such assessment into domestic violence services. Treatment plans should then follow the clinician's assessment of factors likely contributing to the co-occurrence.

<span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;"> <span style="display: block; line-height: 1.5em; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 5px; padding-bottom: 0px; padding-left: 0px; padding-right: 0px; padding-top: 0px;">

<span style="-webkit-composition-fill-color: rgba(175,192,227,0.230469); -webkit-composition-frame-color: rgba(77,128,180,0.230469); -webkit-tap-highlight-color: rgba(26,26,26,0.296875); -webkit-text-size-adjust: auto; color: #4c4c4c; font-family: Verdana,Helvetica,sans-serif; font-size: 12px; line-height: 18px;"><span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">Child abuse is a common diagnosis in the United States and should be considered any time neglect or emotional, physical, or sexual <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuse is a possibility. Although home visitation programs have been effective in preventing<span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child maltreatment, much of the approach to and management of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse is directed by expert opinion or legal mandate. Any suspicion of <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuse must be reported to <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">Child Protective Services. A multidisciplinary approach is recommended to adequately evaluate and treat <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">child abuse victims; however, the responsibility often lies with the family physician to recognize and treat these cases at first presentation to prevent significant morbidity and mortality. [PUBLICATION ABSTRACT]

<span style="-webkit-composition-fill-color: rgba(175,192,227,0.230469); -webkit-composition-frame-color: rgba(77,128,180,0.230469); -webkit-tap-highlight-color: rgba(26,26,26,0.296875); -webkit-text-size-adjust: auto; color: #4c4c4c; font-family: Verdana,Helvetica,sans-serif; font-size: 12px; line-height: 18px;">Childhood sexual <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">abuse (CSA) and adult intimate partner violence (IPV) have both been found to be associated with <span class="hit" style="background-color: #f4e99d; color: #000000; padding-bottom: 0px; padding-left: 2px; padding-right: 2px; padding-top: 0px; z-index: 500 !important;">sexually transmitted infections (STIs) independently, but studies of STIs have rarely looked at victimization during both childhood and adulthood. This paper examines the relationship between CSA, IPV and STIs using data from a nested case-control study of 309 women recruited from multiple health care settings. Overall, 37.3% of women experienced no violence, 10.3% experienced CSA only, 27.3% experienced IPV only, and 25.0% experienced both CSA and IPV. Having ever been diagnosed with an STI was associated with violence (CSA only, odds ratios [OR] = 2.8, 95% confidence intervals [CI] = 1.0-7.5; IPV only, OR = 2.2, 95% CI = 1.0-4.9; CSA and IPV: OR = 4.0, 95% CI = 1.7-9.4), controlling for demographic characteristics. Women who experienced CSA were younger when they were first diagnosed. Understanding how both childhood and adult victimization are associated with diagnosis of STIs is important to reducing the incidence and prevalence of STIs, as well as the associated consequences of STIs. [PUBLICATION ABSTRACT]