Research Paper on "Children Exposed to Domestic Violence: Material"

Research Paper 10 pages (3889 words) Sources: 10

[EXCERPT] . . . .

Developmental Considerations

DV exposure can have considerable long- and short-term impact on teens and younger children. Such impacts include: increased symptoms of externalizing and internalizing behavior; impacts on physical health, such as diabetes and heart disease; and adverse effects on performance at school. Children hailing from minority backgrounds might be unduly affected by DV exposure because of residing in high-crime and high-poverty localities. This article's purpose is to provide school psychologists with additional knowledge regarding the emotional, academic, and social vulnerabilities accompanying children's DV exposure, and information concerning possible interventions when dealing with traumatized persons (Rhonda & Katie, 2015).

Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) integrates child and parent skill-based elements within a trauma model framework. These elements include: parenting skills (behavior-management abilities); psycho-education (facts on trauma and reaction to trauma); relaxation skills (managing physiological trauma reactions); affective modulation abilities (managing affective trauma responses); trauma accounts and handling (correcting cognitive misrepresentations with regards to trauma, and reorganization of memories); cognitive coping (exploring and discussing relationships between feelings, thoughts, and behaviors); future safety planning; and in vivo control over trauma reminders such as overcoming generalized trauma-related fear (Moffitt & Grawe, 2013). Parents and children are taught these elements in both separate child and parent sessions and in joint parent-child sittings (Moffitt & Grawe, 2013). Twelve to sixteen sessions may be held. TF-CBT seems to lessen general problematic behaviors and PTSD symptoms. Recent TF-CBT studies, yet to be incorporated into reviews or meta-analyses, support the earlier conclusions, while also adding fresh insights. For example, trauma narratives aren't essential for successful treatment; additionally, TF-CBT works for children belonging to different age-groups, beginning from preschool age up until high school. As well, there are more therapies, such as Narrative Exposure Therapy for Children and Adolescents (KID-NET), and Eye Movement Desensitization and Reprocessing (EMDR), for children exposed to violence. These methods are currently in the initial evaluation stages (Moffitt & Grawe, 2013).

Theoretical Approach

Cognitive Behavior Therapy

Little children are subjected to a broad frequency and range of traumatic incidents, putting them in considerable risk of developing PTSD. While evidence-based practices (EBP) to assist these young children have been determined, many times children who require care post-trauma don't receive assistance. The reasons behind this failure to treat young children include stigma, costs, limited accessibility of qualified therapists, and logistical hurdles such as child care, work demands, transportation, and time (Salloum, Scheeringa, Cohen, & Storch, 2014).

A therapeutic approach must be the foremost consideration in the development of a child-centric stepped care model. Specific treatment methods may vary within a single stepped care model; however, there has to be evidence to support the delivered therapeutic techniques. TF-CBT marks the most reputable therapy for childhood-PTSD. CBT to deal with childhood ordeals has proven effective for children from different age-groups and backgrounds, in group and individual settings, and also with children undergoing different kinds of multiple traumatic experiences (Salloum, Scheeringa, Cohen, & Storch, 2014). Moreover, CBT has proven effective with varied trauma symptoms. These include children with or without comorbid illnesses such as anxiety, depression, complex trauma demonstration, and/or behavioral issues, regardless of a complete PTSD diagnosis). Creation of childhood PTSD-centered stepped care models for treating all forms of childhood trauma is vital for numerous reasons, including clinician training, implementation ease, and generalizability (Salloum, Scheeringa, Cohen, & Storch, 2014). Different models adopt different theoretical methods for different stages. EMDR (eye movement desensitization and reprocessing), which is empirically supported as a childhood trauma treatment method, may be Step One, and TF-CBT may be Step Two. However, such an approach necessitates that clinicians be qualified and licensed to carry out two different therapies, thus limiting availability of treatment. CBT is utilized in treating many syndromes and the individual therapeutic methods render CBT flexible to explicit steps. Thus, the most extensively researched individual therapeutic model, CBT, was the approach adopted for Stepped Care Trauma Focused-CBT (Salloum, Scheeringa, Cohen, & Storch, 2014).

Cognitive Processing Theory (CPT)

CPT is a valuable psychotherapy method for treating patients who have suffered trauma. This therapeutic approach was developed in 1992 by Resick and Schnicke and colleagues. It integrates exposure therapy with cognitive skill development/restructuring. CPT has historically been tested among a sample of females who were sexually assaulted. Scholars have confirmed the intervention's effectiveness among diverse traumatized populations, such as incarcerated adolescents, refugees, veterans, and automobile accident victims (Basharpoor, Narimani, Gamari, Abolgasemi, & Molavi, 2011).

The treatment's stages include self-esteem and identity development with simultaneous development of advanced interpersonal relationships and skills. Also, at this point, children often face an existential crossroads linked with a novel sense of self; they have to struggle with their losses and the import of currently-integrated memories of trauma. At this point, survivors often struggle with embracing life with revived hope and energy to face the future. To some, this may mean a commitment towards making a difference to the world, especially with regards to reducing violence, an undertaking termed sometimes as 'survivor's mission'(Courtois, 2014)

The treatment duration and course may differ rather dramatically, with various different treatment approaches being employed across the treatment stages. Some of the children may remain for years in therapy, (particularly those with an insecure style of attachment, and those having the largest trauma histories), never progressing beyond Stage One (Courtois, 2014)

Discussion

Apart from direct interventions for treating child victims, numerous other psychosocial approaches are available to enhance psychosocial adjustment of children in the context of violence exposure, either by working solely with their parents, or working jointly with children and parents. These include interventions for preventing child abuse and reducing violence exposure through providing supervision and education to the parents of very young children. Early Start and Nurse-Family Partnership are two interventions-at-home; these approaches have proven effective. Other interventions at the forefront of reducing child abuse risks through better parenting include Pathways Triple P. And Project Support. Treatments aimed at strengthening parent-infant bonds in households where children at risk of being abused are also prominent. For instance, the family intervention, Project Support provides emotional and instrumental assistance to mothers, teaching child-management to them. It was developed originally for reducing behavior problems among children from households using DV shelters (Moffitt & Grawe, 2013).

Another intervention, Parent-Child Interaction Therapy, caters to the child (exposed to violence) as well as his/her non-offending parent. This method aims at improving parental motivation and skills, and improving child-parent interactions. The intervention achieves this through direct parent coaching and direct skills practice in joint child-parent sittings. Preliminary evidence indicates the importance of an extra module (6 motivational sittings) while working towards child welfare with families wherein children suffer abuse (Moffitt & Grawe, 2013). The triple P. method was assessed through cluster design for randomizing 18 South Carolina (U.S.) counties either to Triple P's program on social learning or a usual-care control condition. Subsequent to intervention, lower numbers of discovered child abuse cases, abuse-linked injuries and hospitalizations, and out-of-home care because of abuse, were observed in counties where Triple P. was adopted. This is the first public parenting intervention that has depicted encouraging population- level impacts on child abuse through randomized sampling, with 'county' being the random assignment unit. Clinical as well as experimental research have proven that well-defined parenting strategies are some of the most effective interventions for promoting child well-being and mental health, especially in households wherein maltreatment risk exists (Moffitt & Grawe, 2013).

Case Material

Currently, I am working with Gabriela, a Latina girl aged 12 years, who hails from a background where inter-parental violence has been observed by her. Recently, the client has begun reporting symptoms of PTSD and anxiety. The client cannot function in social settings and reports self-mutilation because of the impact of interfamilial relationships and family dynamics.

TF-CBT Intervention treatment

Twelve-year-old Gabriela faces constant DV at home. During such episodes, her father afflicts physical violence upon her and her little sister. In the mother's first session, the therapist confirmed the mother's distress, praising her courage in willingly supporting her child during TF-CBT sessions, as she was aware that Gabriela will speak about the domestic violence suffered by her mother; this would be a difficult time for her mother. The mother stated that she wishes to aid her daughter, but they were reliant on the father's earnings for survival (Cohen, Mannarino, & Murray, 2011). The mother's wish to ensure her children's protection from domestic violence was addressed by the therapist; this resulted in brainstorming regarding specific approaches which may be adopted by Gabriela and her mother in protecting the girls. The therapist met with Gabriela and her mother and asked questions to help them both recognize any signs that transpired just before violence occurred. They both asserted that her father overindulged in drink, and at such times, he turned furious and violent (Cohen, Mannarino, & Murray, 2011). They both further asserted that her father's not returning home until 8 PM was 'bad', and… READ MORE

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