DIVORCE, CUSTODY AND INTIMATE PARTNER VIOLENCE: EVALUATING TRAUMA IN CHILDREN. Lisa Fischel-Wolovick, JD, MSW

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1 DIVORCE, CUSTODY AND INTIMATE PARTNER VIOLENCE: EVALUATING TRAUMA IN CHILDREN Lisa Fischel-Wolovick, JD, MSW

2 What do we know about divorce and separation? Are all divorces traumatic? What is trauma?

3 Are all divorces traumatic? A range of responses are possible for both parents and children in divorce The risk factors for traumatic divorces include a history of pre-separation interpersonal violence, substance abuse, or untreated mental illness Amato, P.R., Loomis, L.S., & Booth, A. (1995). Parental Divorce, Marital Conflict and Offspring Well-Being during Early Adulthood Block, J.H., Block, J., and Gjerde, P.F. (1986). The Personality of Children before Divorce: A Prospective Study. 57(4):

4 Are all divorces traumatic? Children in less distressed families typically demonstrate resilience within two years. E.M. Hetherington, M. Stanley-Hagan. (1997) The Adjustment of Children with Divorced Parents: A risk and resiliency perspective. 40 J. Child Psychol. Psychiat. 1:

5 What is trauma? Trauma is the experience of an overwhelming or life threatening experience that can cause psychological and neurological changes J. Herman, MD. (1997). Trauma and Recovery. Basic Books. Risk factors for Post-Traumatic Stress Disorder (PTSD) Interpersonal Violence Sexual Abuse Child neglect or abuse War Natural Disasters Genocide American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

6 What are the lifetime effects of exposure to trauma? Neurological development Heart disease Cancer Strokes Chronic bronchitis Respiratory problems Diabetes Increased fractures Hepatitis Felitti, V.J., et. al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14 (4),

7 Adverse Childhood Experiences (ACE s) ACE s can consist of exposure to Domestic violence Untreated mental illness in a parent or care-taker Exposure to substance abuse Child abuse (whether physical, mental, or sexual) Psychological abuse Exposure to criminal behavior ACE s are potentially traumatic experiences

8 The impact of ACE s on children Trauma in the form of ACE s directly effects a child s development ACE s effect a child s immune system Cognition: learning problems Kendall-Tackett has described five pathways in which trauma can harm the body, and can cause neurobiological changes

9 Five Pathways of Kendall-Tackett Physiological Pathways Behavioral Pathways Cognitive Pathways Social Pathways Emotional Pathways Kendall-Tackett, K. (2013). Treating the Lifetime Health Effects of Childhood Victimization. 2nd Ed. Civic Research Institute.

10 What is the public health impact of traumatic exposure to ACE s? Adults who have been exposed to ACE s have increased medical problems and related medical costs Adults can develop chronic pain syndrome, somatic complaints, joint pain, insomnia, fatigue, abdominal pain, severe headaches, diarrhea, constipation, shortness of breath, facial pain, dizziness, nausea, chest pain Kendall-Tackett, K. (2013). Treating the Lifetime Health Effects of Childhood Victimization. 2nd Ed. Civic Research Institute.

11 Adults exposed to ACE s have increased outpatient health care costs for the following Autoimmune disease risks Diabetes Irritable Bowel Syndrome Lupus Scleroderma Mental health risks PTSD Depression Risks persist for decades. Chronic Pain Syndromes Somatic Complaints Joint Pain Insomnia Fatigue Abdominal Pain Shortness of Breath Facial Pain Dizziness Nausea Chest Pain

12 How do we identify a history of DV? Evan Stark defines domestic violence as coercive control Financial Psychological Physical Sexual Stark, E., (2007). Coercive Control: How Men Entrap Women in Personal Life. Oxford Univ. Press

13 In 1984, Duluth Project developed the Power and Control Wheel from women s descriptions of their own experiences

14 What are the psychological effects for adults who experienced abuse as children? Depression PTSD Hallucinations Flash-backs Nightmares Hypervigilance Substance Abuse Chronic Pain These have long-term health care implications and contribute to increased public health costs Kendall-Tackett, K. (2013). Treating the Lifetime Health Effects of Childhood Victimization. 2nd Ed. Civic Research Institute.

15 The traumatic impact of abuse on children by developmental stage Neurological changes Psychological symptoms, children demonstrate these problems differently than adults Pre-school children Nightmares, sleep disorders, bed-wetting, excessive fear. M. Pagelow. (Summer 1990). The Effects of Domestic Violence and Child and Their Consequences for Custody and Visitation Agreements. 7 Mediation Quarterly 347. Adolescents: drug use, sexually risky behavior and depression.

16 Risk factors for sexual abuse Children 6-8 are targeted the most frequently. Children with disabilities are also more frequently the victims Having a step-parent in the home increases risk Girls are targeted more than boys A.J. Sedlak, J. Mettenburg, et al. ( ). Fourth National Incidence Study of Child Abuse and Neglect: Report to Congress. U.S. Dept. of Health and Human Services.

17 Identifying symptoms of sex abuse Sexually aggressive behavior towards other children Nightmares, bedwetting, regression, and sudden fears of one person Younger children display more significant symptoms than older children 10-20% of victims do not immediately display symptoms, but will over time Retrieved March 5, 2015.

18 What is the impact on children of witnessing abuse directed at their primary caregiver? Children can also be traumatized by indirectly witnessing the abuse Hearing their mother being hurt Seeing her injuries Seeing her distress In 50% of the homes where there is DV and children; the children are also abused C. Smith Stover, et. al. (2003). The Effects of Father Visitation on Preschool-Aged Witnesses of Domestic Violence, 18 J. Interpersonal Violence 1149.

19 What are the physical effects of trauma on Children? Chronic pain syndrome Somatic complaints Joint pain, insomnia Fatigue Abdominal pain Severe headaches Diarrhea Constipation Shortness of breath Facial pain Dizziness Nausea Chest pain Kendall-Tackett, K. (2013). Treating the Lifetime Health Effects of Childhood Victimization. 2nd Ed. Civic Research Institute.

20 What happens when these families enter the court system Evaluators may see children having attachments to parents regardless of abuse. Attachment to both parents is a normal part of development. Balancing safety of child against possible attachment. Violence tends to occur around pick up and drop-offs of children Children may be used by the abusive parent to maintain contact and control over the other

21 Risks for Unsupervised Visitation Again, exchange of children can be used to abuse the other parent Post-separation one study found that children who had unsupervised visitation with the abusive parent developed significant problems Conduct disorders, aggression and anti-social behaviors Children s behavior can stabilize, but only after a long time. Shepard. M. (1992), Child-Visiting and Domestic Abuse, Child Welfare 71,

22 Theories Used to Discount Allegations of Childhood Abuse and IPV by using P.A.S. Definition: one parent, typically the mother, plants false memories in the children of abuse, to alienate the other parent, typically the father Not recognized in the DSM-5 Not supported by peer-reviewed research Canadian study found only 4% of allegations were intentionally false N. Trocemé & N. Bala. (2005). False Allegations of Abuse and Neglect when Parents Separate. Child Abuse & Neglect. 29: In U.S. intentionally false allegations are rare (0.02%). U.S. Dept. of Health and Human Services (2002).

23 How can we minimize trauma during custody and visitation litigation? Custody decisions that have clear limits on the abusive parents decision-making authority and communications. Supervised visitations with professionals who understand trauma Exchanges in public, at a precinct, or by non-parent adults Strong judicial orders All of this should be done so that children can respond to subsequent treatment

24 Conclusion What is Needed Supervised visitation facilities Research-based training/graduate education for mental health professionals on trauma, IPV in all its forms Training on the prevalence of IPV in custody litigation Training on risks to children and adults during divorce and custody litigation August 2015