How Can Healthcare Workers Link Victims of CPV With Much Needed Resources? Shedding Light on The Few Resources Available.

Child-Parent Violence (CPV) is a form of domestic violence that is not widely known or recognized by healthcare providers or the community.  As this form of violence emerges from the shadows, healthcare providers will need to know how to manage or direct victims to care as reporting and recognition of CPV increases.  Having access to reliable and confidential resource are the cornerstone of assisting these families in crisis.  The goal of anyone who recognizes this type of violence is to assist in finding resources and providing support to families experience this crisis.

The use of blogging is one underground way to find and gain access to less mainstream types of resources for both victims and healthcare providers.  One very good blog in particular is Holes in the Wall, from Great Britain.  Here is a link to the blog: http://holesinthewall.co.uk.  

Potential resources for families dealing with CPV:

• Domestic Violence Resource Network:  This assistance is funded by the department of Health and Human Services. Their mission is to “inform and strengthen domestic violence intervention and prevention efforts at the individual, community and societal levels” (Family and Youth Services Bureau [FYSB], 2015, 1).
 

• National Resource Center on Domestic Violence: 800-537-2238 www.nrcdv.org and www.vawnet.org: This organization provides comprehensive, free, individualized assistance, training on the effects of family abuse, and resource materials. The organization is funded to provide intervention and prevention of domestic violence. The organization assists in community education, public policy, and systems advocacy for the fight to end domestic violence (FYSB, 2015).

• National Domestic Violence Hotline: 1-800-799-7233, 1-800-787-3224 (TTY), www.thehotline.org:  This is a hotline that is opened 24 hours a day to assist victims of domestic violence.  The hotline offers services in 170 languages.  They assess each caller and for need short and long term (FYSB, 2015).
 

• The Local Police:  If the parent does not feel safe around their child when they are being aggressive or the parent are facing verbal or violent behavior calling the police for assistance is always an option (Help Guide.org, 2015).

 Source:  http://www.sparkbark.com/random-thoughts-musings/fear-is-a-prison/

Additional resources may be available locally.  Exploring what is available in your community is one step each provider can take to help break this cycle of violence. Healthcare providers are a main component of recognizing and linking families experiencing CPV to resources and ensuring these families do not suffer in silence.  

Resources:

Bonnick, H. (2015).  Holes in the wall.  Retrieved from http://holesinthewall.co.uk.

Family and Youth Services Bureau. (2015).  Family violence prevention & services resource centers.  Retrieved from http://www.acf.hhs.gov/programs/fysb/fv-centers.

Help Guide.0rg.  (2015).  Help for parents of troubled teens.  Retrieved from http://www.helpguid

Healthcare Providers: Communication is the Key to Bringing CPV to Light

Healthcare workers are on the front lines when people suffer from violence in their home.  Effectively communicating with patients will assist in broaching the subject of child-to-parent violence (CPV).  The stigma and the feelings of shame victims of violence experience can make communication with the healthcare provider difficult and often times painful.  

Avoiding conversation and not recognizing family violence, including CPV, can result in unnecessary testing, misdiagnosis, and further harm to the victims (New York City Mayor's Office [NYCMO], 2004).  Another consideration is cultural influence on communication and the conversations with possible victims.  “It is critical to optimize your interaction with patients from different cultural groups. Culture influences a patient’s belief system, emotional expression and behavior” (NYCMO, 2004).  

Take these steps facilitate conversations about family violence including CPV:

• Educate yourself about child-to-parent violence
• Recognize that this form of family violence is likely much more prevalent than is currently acknowledged
• Know that the parents and child need help
• Keep in mind help can only come if the abuse is recognized and parents are willing to discuss their abuse
• Begin with open ended questions
• Be non judgemental while listening to responses
• Do not downplay parents’ concerns and remember that serious harm can be imposed upon a parent by their child
• Know local resources for referral and provide follow up care

A study by Salcedo-Barrientos et al. (2014) reported on the seemingly low disclosure rate of domestic violence and pointed out the following issues:  “lack of education and training of health care professionals; failure in the identification and intervention process due to bias on their personal problems, [and]moral attitudes.”  Learning to communicate in an open and unbiased manner is imperative when healthcare providers are dealing with CPV.  The stigma surrounding CPV can be amplified by the health care provider’s lack of sensitivity to the victims and family members.  

References:

Salcedo-Barrientos, D.M., Miura, P.O., Macedo, V.D., & Egry, E.Y. (2014). How do primary health care professionals deal with pregnant women who are victims of domestic violence? Revista Latino Americana de Enfermagem. 22(3), 448-453. doi: 10.1590/0104-1169.3108.2436.

New York City Mayor’s Office. (2004).  Medical Provider’s Guide To Managing The Care of Domestic Violence Patients Within a Cultural Context.  Retrieved from http://www.nyc.gov/html/ocdv/downloads/pdf/Materials_Medical_Providers_DV_Guide.pdf

Common Risk Factors of Child-Parent Violence: What Everyone Should Know

Child-Parent violence (CPV) is an under reported aspect of family violence.  Why is it so under reported?  Unfortunately when people refer to ‘domestic violence,’ the situation of a son or daughter physically or verbally abusing their mother or father is not the first or even second thought that comes to mind.  Walsh and Keinhart (2007) wrote, “Due to gross underreporting and the secretive nature of this crime, accurate estimates of frequency and prevalence are elusive” (563).

Source:  http://wendiw.hubpages.com/hub/Parental-abuse

Cottrel (2001) wrote that CPV is an act performed by a child done to intentionally cause physical, psychological, or financial pain to gain control and power over a parent.  There is little doubt that the stigma and feelings of disappointment play a role in underreporting episodes of CPV, but the lack recognition of what CPV can also play a role. 

In an article in the Guardian (2009), a recounting of a mother being attacked by her daughter is described.  One resounding statement in the article was the mother’s disbelief of what had happened (Lewis, 2009).   Another point Lewis (2009) described was that when parents used the CPV help call center is was to confirm that the episode was truly CPV (2009). 

Clearly recognition of CPV and the risk factors is one of the first steps for families, healthcare providers, and communities in increasing reporting of CPV. 

Commons risk factors for CPV:

• Males between 10-18 are at higher risk of perpetrating CPV. 
• Single parent homes are at a higher risk.
• Mothers are more often victims then men.
• Families that children witness inter-parental violence are at higher risk.
• Children who have experienced violence from a parent is at higher risk of perpetrating violence toward a parent.
• Having a difficult child-parent relationship.
• Parents with unrealistic expectations for children and family.
• Poor or absent communication skills of parents and eventually children.
• Children that have a low frustration threshold.
• Children who have behavioral disorders are at higher risk of perpetrating violence towards a parent.
• Children that display disruptive behaviors at home and/or at School. 

Source: http://www.angelsthatcare.org/silent_abuse.html

Being cognizant of the risk factors for CPV is the first step in improving the reporting rates.  Whether you are a healthcare provider, community member, friend, family member, or victim if you recognize the risks speak up and offer assistance to those in need.

Resources:

Cottrell, B. (2001). Canada: The Family Violence Prevention Unit Health. Parent abuse: The abuse of parents by their teenage children.

Ibabe, I., Jaureguizar, J., & Bentler, P.  (2013)..  Risk Factors for Child-to-Parent Violence. Journal of Family Violence (28), 523–534.  DOI 10.1007/s10896-013-9512-2 .

Lewis, C. (2009).  The day my daughter hit me.  The Guardian.  Retrieved from http://www.theguardian.com/lifeandstyle/2009/jun/27/parental-abuse-domestic-violence.

Walsh, J. & Krienert, J. (2007).  Child–Parent Violence: An empirical analysis of offender, victim, and event characteristics in a national sample
of reported incidents.  Journal of Family Violence (22), 563–574.  DOI 10.1007/s10896-007-9108-9.

Living in the Trenches of Child-to-Parent Violence: A Mother’s Journey

Although child-to-parent violence (CPV) is a form of family violence, its victims find themselves in a seemingly impossible situation.  Why you ask?  What is the first thing that comes to mind when you hear of someone being abused?  For many, it is the thought, “the victim needs to leave the abuser and seek help.”  But what is a parent to do when it is their child who is abusing them?  A mother experiencing years of violence at the hands of her young son wrote the following passage that describes this distinguishing feature of CPV compared to any other form of family violence.

I am a battered woman  

My body is beaten and my soul, broken

The irony is that I cannot run from the cause of such heartbreak,

rather it is my responsibility to run to it, embrace it,

and do what everyone says cannot be done…

CHANGE HIM

This is because at the cornerstone of my world

is the very being that brings such conflict to my life

My very own flesh and blood, my child

This mother describes a family outing to dinner where, in a packed dining area, her six year-old son asked her if she would visit him in jail when he got older.  She was shocked by his question and asked him why he thought he would be in jail.  He responded that he didn’t think he would be in jail, but rather he KNEW he would be.  He didn’t want to talk about the specifics any further, but insisted that his mother answer his question...would she come visit him?  Would she come every day?  

She answered yes, that she would be there for her son in any she could be, as she glanced down at the area on her forearm where he had bitten her the other day.  The teeth marks had faded and transformed into an area that was swollen and bruised.  She caught herself being thankful that it was winter so that she could wear a long-sleeved shirt.  That was the first time there was a flicker of recognition that what she was experiencing could actually be considered abuse, even though the punches, slaps, bites and kicks had been coming for years.

Later that night, her son told her he knew he would go to jail some day because he hurts her and that is where “bad people” go.  She hugged him tight as tears streamed down her face, wondering how she was going to find the help that he so desperately needed.  It hadn’t come yet despite the countless doctor appoints and behavioral therapy.  

A year later, her younger son lay down for bed one night and asked through tears what would happen to his brother if he killed her one day.  Again, she found herself reassuring her child, holding back tears and hiding the fact that she too shared the same fear.  Flashbacks of sheltering herself and her younger son behind locked doors to protect themselves from her older son's rages teared through her heart and mind. She knew it was going to be a long road, but wished more progress had been made towards a peaceful household over the previous year.

As the story above illustrates, experiencing CPV first hand is devastating.  It often occurs in families that are very caring and nurturing.  If you are experiencing CPV, remember these things when trying to cope:

• It is not your fault
• Both you and your child need help
• You are not expected to have the resources to parent a violent child all on your own
• Lean on others
• Seek professional help

When parents begin to experience CPV, it may be instinct to think the violence is the result of pure lack of discipline in the home.  This is where the guilt that parents place on themselves first comes in to play.  They may react by becoming more strict, only to see an increase in violent attacks by their child.  After the violence, the child may express genuine sorrow and regret, which paints a similar picture to the violent spouse who is later sorry for their outrage and begs forgiveness.

What is the abused parent to do?  It is important to keep in mind that children committing CPV are at increased risk for mental health disorders including Disruptive, Impulse-control and Conduct disorders in addition to  Attention Deficit Hyperactivity disorder (Ibabe et al., 2013; Ibabe et al., 2014).  Any child committing CPV needs to been seen by a healthcare provider for evaluation.  Steps taken from there will vary depending upon the presence of any underlying treatable mental health disorder.  

It is important for others to provide a safe and nurturing environment where the parent and child can openly discuss family dynamics and struggles.  A literature search of treatment for CPV yields very little, as research on the topic is in its infancy and thus has primarily focused on determining the prevalence of CPV and defining risk factors.  This important research is paving the way to a better understanding of this form of family violence, but there is much more research to be done.

Along with researchers, families experiencing CPV play an important role in rising this form of family violence from the darkness by speaking of the violence that occurs in their lives.  Others can help as well, by not turning a blind eye to the existence of CPV and not assuming poor parenting has resulted in the violence these parents are sucummed to.  These families need support and guidance, not judgement and isolation.

References:

Ibabe, I., Arnoso, A., & Elgorriaga, E. (2014). Behavioral problems and depressive symptomatology as predictors of child-to-parent violence. European Journal of Psychology Applied To Legal Context, 6(2), 53-61. doi:10.1016/j.ejpal.2014.06.004.

Ibabe, I., Jaureguizar, J., & Bentler, P. (2013). Risk Factors for Child-to-Parent Violence. Journal Of Family Violence, 28(5), 523-534. doi:10.1007/s10896-013-9512-2.

Silence rules over child-to-parent violence. You can take steps to change this.

Parents who are victims of abuse at the hands of their children are reluctant to speak up and, in turn, this form of family violence is thought to be grossly under-reported.  There are several factors that contribute to this reluctance.  For example, parents may:

• Blame themselves for the difficulties they experience in controlling their children
• Be reluctant to discuss their child’s violence for fear that their child will be prosecuted by the law
• Be afraid of rejection and being stigmatized once they reveal that they are being subjected to abuse by their children

Source:  http://afriqaustralia.org.au/?p=90

A brief review of the literature makes it understandable that parents often blame themselves for their child’s poor behavior.  Placing blame on parents has been a longstanding problem when discussing childhood disorders, among the most memorable is the concept of the “refrigerator mom” and the belief that this description of detached mothering caused autism.  We now know that this was a false belief and need to be very careful about perpetuating this type of thinking as it relates to other disorders and childhood behavior.

The literature today continues to contain reports of studies that aim to link parental behavior to behavioral problems in children.  Han and Shaffer (2014) state “…it has been widely accepted that children’s emotion dysregulation and risk for psychopathology is mostly shaped by their social environments, with particular emphasis on the family context.” However, it is very difficult to ascertain if these parenting styles labeled as criticizing actually cause childhood behavior problems or are a result of parenting a child with a difficult temperament, which the authors point out is a limitation of their study.  

What really needs to be asked is, how can an environment free of stigma and blame be fostered so that struggling parents can seek the help they so desperately need?

To answer this question and work towards an environment that fosters open and honest communication, we can look to the work that has been successful in reducing the stigma of intimate partner violence.  Social media campaigns that increase awareness and reduce the stigma of CPV are important, as are federal policy changes that increase surveillance of CPV.  Better reporting will allow for a better understanding of CPV prevalence and identification of families most at risk. Medical training curriculum needs to be revised so that health care providers are equipped to screen for CPV, have empathetic conversations about CPV, and are familiar with resources for these vulnerable families.

You can help in the following ways:

• Develop a clear understanding of CPV
• Remember that some parents struggle in raising their children
• Open lines of honest communication
• Ask open ended questions about parenting experiences and outlook
• Thoroughly explore areas of concern
• Be supportive and nonjudgmental

Source:  http://www.iwannaknow.org/teens/relationships/abuse.html

Reference:

Han, Z. & Shaffer, A. (2014).  Maternal expressed emotion in relation to child behavior problems: Differential and mediating effects.  Journal of Child & Family Studies. 23(8), 1491-1500.  doi: 10.1007/s10826=-14-9923-6.