Evan Stark, Ph.D, MSW*
11 Forest Trail
Woodbridge, CT. 06525
*Professor Emeritus of Public Affairs and Public Health, Rutgers University
The Political Context for the TF
There were high expectations when the TF was formed in July 2015. In the past, when a child like Aeden Moreno was killed in some proximity an obvious system failure, as here, special review panels were established, but with limited mandates. Not so in this instance, though I’m not clear, since CT. no longer appears to have an effective office of the Victim Advocate. Still, it was gratifying that the TF was given a broader mandate, even though it became immediately clear that its staff, composition, funding and time table prohibited the sort of comprehensive overview and environmental scan the mandate implied. Even so, perhaps because there are so few other avenues for recourse on this issue, there was hope that the TF would at least outline a broad agenda of reform that could begin the process of bringing CT.’s response to partner abuse in line with the response of other states.
The Governor’s leadership on gun control, immigration and educational reform and many other issues is unquestioned. However, violence against women and children in the home has not been a high priority. Would this now change? Would the TF address the three institutions which immediately failed Aeden Moreno, the family court, the criminal justice system and DCF, or would it simply echo the current work of these institutions and call for more of the same? Even if there were no survivors on the TF or direct representatives of our shelters or domestic violence experts, having a Co-Chair from the CCADV could convey a sense of the problem as our clients see it, for instance, by pointing to the maze they experience when they try to negotiate in the various court systems, the victim-blaming from family court and child welfare and the extent to which so many mental health, health, legal, police and child welfare professionals still disparage women who either acknowledge abuse or hesitate to “do the right thing” simply because a frontline novice who has not walked in their shoes tells them to do so. There is no greater cause of risk to children in abusive homes that the failure of our existing systems to protect them and/or to hold those responsible to full account. Would the TF address this cause?
The broad political context should be well known. CT’s Family Violence Prevention and Response Act in l984 (for which I provided testimony) put the state at the forefront of stopping violence against women as did our negotiation of mandatory arrest policies, post Thurman, in exchange for relieving police of liability for neglect. We were among the first to create batterer intervention programs as a state supported intervention. By mandating health training through a Domestic Violence Training Project (DVTP) which I co-directed over almost 15 years, CT. was also a leader in health reform. In collaboration with CCADV, DVTP and the Ct. Medical Society, we launched an award-winning initiative to bring private practitioners on board, helped make screening for abuse a condition of licensure for health care institutions and implemented innovative service initiatives in our Community Health Centers. Today, every hospital and medical patient in the state is asked about abuse. While DCF was slow to sign on, we were able to develop a pioneering identification protocol under my direction, integrate advocates into local offices through the Safe and Together model and to win the Department’s commitment to shift its focus, in abuse cases, to hold perpetrators rather than victims responsible—CT.’s mantra “something is seriously wrong if the service plan for the victim is longer than for the perpetrator” went viral nationally. Lacking a strong Domestic Violence Fatality Review Board, CT. nevertheless created an independent Victim Advocate who, despite virtually no staff or support from her board, used individual tragedies as a springboard to identify gaps in the system response and propose remedies.
I don’t need to remind the TF that most of these reforms have either been abandoned or, like the Safe and Together model and the Victim Advocate, allowed to atrophy. A recent report from a self-appointed panel consisting mainly of psychiatrists has recommended dismantling our batterer programs and replacing them, no surprise, with individual and group psychiatric and behavioral health. Bold self-criticism, review and system reform led by the Governor’s office and the House Judiciary Committee has been replaced, over the last decade, by piecemeal reform. Suffice it to say, that CT. is now the laggard nationally with respect to reform in the domestic violence field. So, are we now ready to get back on track, particularly with respect to the three public institutions that are most directly responsible for the safety of abused women and children in our state, institutions our clients experience as separate “planets,” the criminal justice planet, the family court planet and child welfare?
Protective Mothers on the March:
A few months before the TF was established, a small army of protective mothers waving their bills from court appointed guardians, et al. stormed legislative-sponsored hearings to present grievances about their reception in the family court. Most of these moms had lost custody or been forced to share custody with abusive husbands, been dubbed “alienators” when they persisted in pressing the abuse and some had even been denied access to their children. Their main point was about as subtle as a ransom note: children are not safe, if their mothers are not safe and neither is safe if the family courts persist in insisting on access for abusive men. CT. remains one of only a handful of states whose courts give no special weight to domestic violence or the harms it poses to children. This is easily fixed. Other states, Colorado, NewYork, California…have gone a long way towards doing so. So is the TF on board with this?.
The Failure to Protect Aeden Moreno:
The immediate prompt for the TF was a tragic case that underlined that real lives are at stake in the complaints women brought to the hearing. Real daughters, real sons, real sisters and mothers and neighbors and coworkers. Low-income and minority women are over-represented in the DCF caseload and it takes money to win custody from an abusive dad intent on extending his control through the courts. But both groups share a common concern for the safety of their children.
On June 5th, 2015, Tony Moreno drowned his 7 month old son, Aaden. Less than a week earlier, family judge, Barry Pinkus, found that neither Aaden nor, Adrianna Oyola, his mother, faced the “imminent risk” of physical violence from Mr. Moreno required to extend the Order of Protection and full custody she had been granted by another judge. Judge Pinkus lectured the couple about their ‘immaturity” and ordered the mother to “work out” a custody arrangement with Mr. Moreno, a man who, according to the Sheriff’s report, had just destroyed his cell along with other possessions. As ordered, Aaden was turned over to Moreno. Pinkus never bothered to review a record of Moreno’s threats and violence against Ms. Oyola, including assaults when she was pregnant, as well as against the baby, including a threat to “make him disappear.” Mr. Moreno had stalked Adrianna; taken her money; isolated her from her family and controlled her in numerous others ways. A police warrant was pending for violating the OP. Called to investigate Moreno, DCF had investigated Ms. Oyola instead, but reported she was doing everything needed to keep the baby safe. Judge Pinkus either ignored this report or wasn’t impressed.
Following public criticism of Judge Pinkus’ decision, the Chief Administrative Judge, John Carroll III, came to his defense, emphasizing the “liberty” rights of Mr. Moreno (but not the child’s rights to safety) and that Judge Pinkus’ decision was “representative of the difficult decision that judges must make each and every day.” Like the Press, Judge Carroll was silent about the fact that in 2007, this same Judge Pinkus had removed another young child from another young mother whom he thought “immature” and given full custody to the another abusive dad, a man named Joshua Komisarjevsky, even though he had appeared in court wearing an electronic bracelet because of his abuse of the mother and had a long criminal history and history of psychological problems. Interestingly, DCF and the parole department supported Komisarjevsky’s petition because of his never substantiated allegations that the young mother whom he had abused used drugs. I don’t have to remind you how this “difficult decision” turned out. Not then and not now has Judge Pinkus been held to account, criteria for OP reviewed, standards set for judicial review of the record or any other reform been proposed by Judge Carroll or the legislature. This situation is not easily fixed. But fixes are readily available.
Dual Arrests:
While the TF was deliberating, another reality surfaced, that Connecticut has the highest proportion of dual arrests in domestic violence cases in the U.S. The failure of Connecticut to adapt a “primary aggressor” statute (forcing police to identify who is mainly responsible for the pattern of abuse) has a complicated history, including the belief that legislators would be too intimidated to alienate Fathers’ Rights groups to go for such a law. Dual arrests, which can be justified in a few cases, are universally recognized as indicators of poor police training and the resulting cynicism, particularly when the same men go through the revolving door of arrest, nolle/dismissal, BIP, abuse, arrest, etc.. No child in CT is safe unless their mother is safe and abused moms are not safe if they face arrest when they call police. Dozens of my clients have told me they have not reported their abuse because they feared arrest. This is not easy to fix. But fixes are available.
It was our hope that the TF would address these realities. So, when I read the TFR, I asked myself: is there anything here that addresses the grievances the mothers presented? Is there something here that would change the views or the behavior of Judges like Pinkus or Carroll? If these recommendations are adapted, will DCF be more likely to hold an offender accountable? Will dual arrests be reduced? Will the family court be more likely to recognize that coercive control of the sort Adrianna was facing presents as much of an ‘emergency’ as violence? Is there anything here that, if enacted, would have prevented Aaden’s death?
Background and Assumptions:
The first challenge in talking to the TF and the Legislature behind it is to establish a context for dialogue about change. The TFR perpetuates a number of myths, as much by what it doesn’t say as by what it does, and makes several recommendations that are extremely unwise, will do nothing to protect children and almost certainly will lead to an increase in victim blaming and suffering by our clients. The most insidious proposals, the most victim-blaming and harmful, involve suggestions that progressives on these issues everywhere have rejected: these call for a greatly expanded role for DCF via police reporting of children at domestic violence scenes; mandated reports (to whom?) of children exposed to domestic violence; and the maintenance of a state registry of all children who come before courts for any reason. This last idea is almost certainly unconstitutional, violates the privacy rights of children (parents by proxy), heightens the atmosphere of intimidation in the family and probate courts; and has no redeeming purpose to justify the burdens and risk of maintaining such a base. NJ is just the most recent state to reject police reporting to CPS just as NYC just finished a comprehensive review of the type of family preservation initiative in abuse cases now in place at DCF, which it rejected because there was no way to differentiate the large proportion of cases in which such a strategy would leave women and children at risk. The mandated reporting of exposed children has no possible rationale: it would be an administrative nightmare for DCF (since the vast majority of cases would prompt no further action), add nothing to current interventions, further inhibit reporting of abuse by mothers and so on. I don’t blame the TF for adapting these dangerous proposals: without adequate staff, time or adequate funding, counsel, how could it be expected to do anything but pass on what the constituent organizations and fee witnesses brought to the table? DCF wants this…the judges want this…but what is good for children?
At the same time, there are proposals in the TFR that merit support, particularly those involving expanded (and mandated, as in NJ?) judicial training, importing anti-violence education into the younger grades, wider support for home visiting and so on. Each of these programs comes with qualifications: when home visiting ends, abuse levels tend to rise; ‘zero-tolerance’ has been shown to increase bullying, not prevent it; anti-violence education that is not gendered is highly ineffective. Here, though, the TF is on the right track here.
In the following comments, I follow the outline of the Report. Where the Report provides some background of the problem, I provide 10 basic facts about child exposure. Then I list 5 assumptions/principles for protecting children exposed to abuse that reflect best practice in the field. I am happy to provide supportive documentation either from my own research/writing or that of others for any of my claims.
While the TF may not be the proper forum, there has never been a better time for a state like Connecticut with a history of leadership on this issue to convene, staff and fund a standing review panel to rethink our entire approach to protecting the abused women and children in our catchment. As Betsy McAllister Grove would be the first to point out, the field of research, policy, law and practice with respect to responding to partner abuse in general and protecting children in particular has never been in greater flux—much of what we thought we knew or understood has been challenged and replaced by models of thinking and practice that appear to be far more accurate and effective than what was thought and done in the past. While this makes the present a very exciting time to address this issue, because maybe we have it right now, it means that approaches that rely on outdated conceptual models and are designed to shield existing systems from criticism rather than to open them to public scrutiny will do little more than repeat the errors that led to Aeden’s death and that prompted the mothers to express their anger in a hearing room far from the halls where real decisions are made.
TEN FACTS ABOUT CHILD EXPOSURE:
1. All children in homes where partner abuse occurs are affected by the abuse. This is true even when parents insist their children have not been exposed.
2. A very small proportion of children are exposed to the most severe forms of violence against their mother, about 1%, and fewer than half of this number are traumatized by this exposure, certainly fewer than .05%. These children require assessment and sometimes sustained treatment. I support clinical services for this group. But we would never want to build our larger clinical approach to child exposure as a response to the PTSD and other severe dysfunction occasioned in fewer than 1 exposed child in 100.
3. On average, children exposed to domestic violence/coercive control experience more short and long-term problems than children not so exposed. As the TFR notes, these problems run the gamut, may differ by gender, type of exposure, developmental age, duration or exposure and the type of abuse to which they’re exposed and, very importantly, resiliency and support, particularly from the non-offending victimized parent. However, a number of studies show that children exposed test psychologically normal.
4. Many problems once attributed to “witnessing” abuse turn out to be the result of other insults in the environment, such as direct child abuse, sexual abuse or extreme isolation/control. Recognizing the varied nature of children’s “exposure” and/or involvement in abuse, the literature no longer focuses on “witnessing.”
I cannot support the claim in the TFR that >40% of abusive men commit child abuse, at least in the legal sense, though many do. But, we do know that 40-60% of the CPS caseload consists of battered mothers, most of whom have come into the caseload because of the direct or indirect effects of being abused. There is no evidence of which I am aware that these mothers either belong in the CPS caseload or are well served in this caseload. Studies show they are far less likely than other women in the caseload to have multiproblem backgrounds, mental health problems, substance use or other behavioral problems, for instance, or to lack parenting skills. The stigma and other consequences of CPS involvement far outweighs any benefits they derive, on average, from this contact. I say this not only based on data but as someone who oversaw for the federal court the largest CPS system in the world. We should either expand the statutory mission of DCF to include responsibility for the safety of these mothers as well as their children or find another track, as they have in Michigan for instance, for dual victim families like these.
5. In general, most of the problems demonstrated by children exposed to partner abuse are no different than the problems exhibited by children who suffer other traumatic events for which we do little or nothing, such as divorce, serious illness or the loss of a parent, e.g. or who witness violence in the community. We would never consider mandating professionals to report these children to DCF or collect their names in a data base or ask police to record their presence at a domestic violence scene.
6. The vast majority of children exposed to abuse, well >80% and in some samples over 95% even in shelter samples, where you would expect to see the most severe violence, show no long-term psychological problems associated with exposure. This is important because people who don’t understand what we mean by risk may be confused into thinking that the higher risk children face because of abuse exposure means that most children so exposed have these problems, which they do not. This is very important because it means that any intervention based on assumption of generic risk is extraordinarily cost ineffective and even harmful—since ‘treatment’ via DCF or other agencies cannot be assumed to be benign. As the NY and federal courts have wisely found, the only exposed children for whom a DCF referral may be appropriate are those who have demonstrated effects of abuse exposure and whose behavioral, psychological, learning or emotional problems cannot be more efficiently addressed in some other way.
7. The violence/trauma model which guides much of the thinking in the TFR about exposure is too limited. Most child harms from abuse exposure result from exposure to coercive control, not domestic violence.
Betsy McCallister Groves was one of the first to show that it was chronicity, not the intensity of violence, that harmed children. The vast majority of abuse cases that come to our attention (because someone seeks shelter, calls police, seeks an OP, or is reported to DCF or by schools) involve coercive control, not the type of domestic violence that is anticipated by domestic violence laws, our Order of Protection statutes and/or the Campbell dangerousness assessment tool referred to in the TFR and embraced by some family judges in CT. The violence involved in CC typically includes frequent, but generally low level assaults (pushes, shoves, punches, hair-pulling, choking, etc.), nothing anyone wants done to them, but not the sort of violence that is likely to cause the harms to children trauma models anticipate. Seeing your mother pushed, punched or even knocked down may be upsetting. But it is rarely traumatic. Domestic assaults are significant not because of their intensity (the traditional trauma model) but because of the cumulative sense of entrapment they create for victims and children. If anyone doubt this, google the 2010 CDC population survey. In CT., the typical female victim has suffered dozens, even hundreds of attacks, some thousands, almost none of which have required a medical visit or even a police call. The average duration of these assaults is 5.5- 72 years.
As importantly, in coercive control, the pattern of low-level violence is accompanied by some combination of sexual coercion, stalking and other forms of intimidation/surveillance, isolation, degradation and deprivation of money and other resources and control over daily life. Under our present laws and surveillance systems in CT, this pattern remains invisible albeit in plain sight. In other words, the main form of abuse that jeopardizes children is still largely invisible to the systems we have established to protect them.
ADDENDUM on Reporting: Mandated reporting of child abuse or child sexual abuse by professionals has two functions, to identify criminal offenders and victims and to prompt emergency protection because of a presumed imminent risk. Exposure of children to partner abuse meets neither of these criteria: it is not and should not be a criminal offense and, as the points above make clear, it rarely comprises the sort of emergency or requires the sort of protections anticipated by requiring reporting of child abuse. We have known for decades that even the mandate that MDs report child abuse inhibits reporting. Imagine the extent to which reporting would be inhibited if mothers knew their child would be reported to DCF. Instead, best practice models reject reporting mandates where child exposure is concerned and train police, case workers and health providers workers to establish the sort of ongoing relations with patients and children we try to model in our shelters. Safety plans, strategies for survival, etc. are reviewed at each visit.
8. Jumping ahead, we need to completely rethink how children are harmed in these cases and the level and type of services required particularly the notion of the sort of ‘emergency’ that requires a police officer to report a case to DCF or for DCF to jump in. Child exposure is a nuanced facet of an ongoing pattern of coercive control and is best managed as part of a larger and ongoing intervention strategy. Consider this a chronic health model of intervention rather than a model of acute care.
By contrast, consider one consequence of DCF involvement, namely foster care. We know that rates of child problems in foster or residential care are as high or higher, including rates of CA and CSA, by factors of 2x to 3x, than in the general population and only slightly lower than reported rates in homes were children are exposed to severe domestic violence. This is why the Federal Court (and the Appellate Court in NY) ruled in Nicholson that reporting to CPS and removal were only justified if CPS could show concrete harms, that there was no way to remedy the violence exposure without removal and, most importantly given the recommendations in this report, that removal was less harmful than the status quo. While CT is not technically covered by the Nicholson decision, previous DCF Commissioners had agreed to comply with Nicholson. And Judge Katz did as well, early in her tenure.
9. The main harms children suffer in these homes are not the result of exposure to violence, but exposure to the rules, isolation, surveillance, including cyberstalking, and other nonviolent tactics both indirectly, as their mother’s capacities for independent action are disabled, and directly, as the abuser targets the child with these tactic or “weaponizes” the child for use in controlling the mother. Nothing in the TFR anticipates this pattern of harms, which is the modal pattern and which counselling, wrap around services, DCF referrals and so on can do little or nothing to remedy.
9a. The Dangerousness Assessment tool adapted for the family court, like our “imminent danger” standard for the OP, is constructed around the outdated and mistaken belief that severe violence poses the major threat in abuse. In fact, a number of studies now show that the highest risk of homicide to mothers and children is a function of the level of control in the relationship, not of the violence itself, including control over money, transport, access to family and friends and so on. This is because what puts a woman at the highest risk, and disables her capacity to protect her child, is her ability to effectively resist or escape when assaulted. This is what is undermined by coercive control. This is why we say that partner abuse is not only about what men do to women and children, but what they keep women and children from doing for themselves, and why we have placed such a high premium on empowerment as a frontline strategy for child safety.
10. All of this—the harms, the dynamic, the effects, are gendered and rooted in sexual inequality. Every country in the world except the United States recognizes the difference, in terms of dynamics and consequences for children, between hitting and fighting and abuse, identifies the latter as a form of discrimination and approaches it differently than traditional assault is approached. Any curriculum, intervention or service that doesn’t acknowledge the role of male privilege, inequality and the focus of abuse of children on gender is doomed to fail. Protecting children from abuse is not about ending violence in their homes, or not primarily, but about preventing domination and helping children learn that the opposite of abuse is not merely nonviolence, but respect for equality. If you want to see how this works in practice, google any elementary school violence education class in Wales.
FIVE PRINCIPLES TO GUIDE BEST PRACTICE
1. Starting with Janet Reno, who first articulated this principle, every objective observer who has worked in this area has eventually come to appreciate that the best way to protect children from domestic violence and coercive control is to effectively empower the primary care giver. While the TFR mentions this, it has little or nothing to say about how this should be accomplished. For instance, it is silent about:
a) What this means for statutorily expanding the mission of DCF to include the safety of all family members—any program that purports to protect children without protecting their mothers is a form of disguised betrayal. If we are serious about using DCF has a frontline response to partner abuse, than we need to hold it accountable for safety of women as well as children. If we are not ready to hold DCF accountable for the safety of the whole family unit, then we have no business using the agency as a frontline response.
b) What it means for how family courts approach allegations of abuse. Colorado has gone a long way to reducing complaints from protective mothers by setting a priority on safety alongside the child’s best interest, hearing domestic violence evidence before the case in chief and prohibiting the family court from punishing mothers who violate court orders (such as providing the abuser access to the child) out of a sincere desire to protect the child. Adapting this simple approach would protect thousands of CT's children annually from abuse;
c) What this means for therapeutic interventions which see the child outside the context of the parent-child dyad.
2. All interventions to help children should be based on ‘partnering’ with the non-offending parent and viewed as part of her safety plan, including interventions where children are seen separately. While children old enough should have independent safety plans, this should be coordinated with the mother’s safety planning. This is a major reason the health or home visitor programs are so effective, at least until the visitors leave.
3. Alongside empowering abused mothers, the most effective way to protect children is to hold perpetrators of domestic violence/coercive control, almost all of whom are male, solely and fully responsible for their behavior. Numerous studies show that child harms are directly transmitted from the perpetrator of wife abuse regardless of the mother’s behavior. Coercive control is not a symptom of mental illness, behavioral health problems or an inability to control one’s temper or manage conflict. Rather than it is a deliberate course of conduct designed to secure privileges by subordinating women and children and depriving them of rights and resources they need to thrive. Unless our criminal law reflects the seriousness of the harms inflicted by broadening the definition of domestic violence to include coercive control and establishing coercive control as a Class A Felony, police and the criminal courts will lack the proper tools to protect children from these men. CT.’s failure to hold perpetrators of abuse accountable for the harms they cause is the single biggest risk factor for children’s well being in abusive homes.
4. Interventions to help children should recognize the ‘rights’ and equality dimensions of abuse as well as the harms dimension. Because children do not technically have “rights,” such as the right to autonomy, dignity and so on, it is critical that significant adults be empowered to protect these rights. Our Guardian system is not set up to protect children’s rights, but only their supposed ‘interest.” This is why NY has replaced its guardian system with “lawyers for children.” While this system is not perfect since it still assumes a potential conflict of interest between the abused mother and her child, it is a major step in the direction of giving children real voices in family matters. England uses a separate track of advocates for children in all court proceedings. If someone was taking men’s money or limiting their movement or telling them how to drive or dress or cook or clean and then hurting them, this would not be considered an issue of ‘trauma’ and ‘abuse,’ but a violation of their rights to autonomy, dignity, resources and liberty. We do not notice rights violations in women and children nearly as readily. This language needs to be instilled in children as well as their mothers and should be as much a part of ‘re-education’ as it would be with someone who had been raised as a child soldier or in a POW camp. “Trauma sensitivity’ should be complemented by training in ‘rights’ sensitivity. This is difficult with young children and almost certainly should be part of the voluntary education about parenting we do with moms. Thousands of children in abusive homes are forced into rigid gender stereotypes alongside their mothers and treated as indentured servants, behaviors that harm them as much if not more than exposure to violence.
5. Because coercive control is ongoing, interventions must be structured around services that are ‘ongoing;’ because coercive control extends abuse of women and children through social space, to school, work, markets and so on, interventions must be similarly sited. Mobile means of accessing safety need to be available to young people just as they are to their parents and priority should be placed on DCF, police and other state agencies getting re-engaged with community partners, including businesses. In the interim, our system of community-based shelters should be funded to extend its support for clients for at least the year after they no longer require emergency services. Elsewhere in the world, support for housing and services for battered women and their children extends to two years or more. Child deaths in these settings are almost unheard of.
THE TASK FORCE REPORT:
- HEALTHCARE
Comment: In addition to the 3 forms of prevention cited, t is now important to engage child exposure through ‘complex social prevention.’ This refers to changing the conditions that lead to a problem, in this case, confronting sexual inequality even as we work with individuals.
In public health terms, prevention means keeping new cases from arising by reducing what we term the “incidence” of child exposure. In order to know whether prevention is working, we have to define when a case is “new” and when a case is “ongoing.” Other forms of intervention target the ongoing cases in the community, what is termed “prevalence.” Until recently, we have only used a criminal justice definition that equates partner abuse with assaults. Since each assault is considered a separate crime, we had not understood how to differentiate new from ongoing cases. We have just recently begun to change our definitions to acknowledge that the vast majority of cases of partner abuse, hence of child exposure, are relatively long standing and that the incidence (new cases) of partner abuse is relatively low, probably less than 15% of the total. This means that if we had an effective early intervention strategy, we could reduce the cumulative burden of child exposure by 85% or more.
The most effective early interventions are those that combine a sensitive screen, an assessment of coercive control, strong empowerment for victimized mothers and speedy and robust interdiction with offenders.
Policy and Procedure: Policies that support screening, early identification, and cross-sector collaboration will allow for healthcare providers to engage in primary, secondary and tertiary prevention. These policies should be supported, as they have been in CT., since the mid-1980’s. While we applaud the health training initiative of CCADV, the state should once again fund a training department or program consisting of health trained professionals to replicate and extend the earlier work of the DVTP.
While Dr Grasso is right that children face polyvictimization in abusive homes, it is unclear where this leads, since inviting young children to discuss abuse in their homes is still quite controversial, particularly since we have no effective means to protect them or their mothers from the effects of such disclosure. If a pediatrician or other MD suspects coercive control, the best approach remains a discussion with the suspected target of abuse and, as trust builds, joint safety planning for or with the child if of proper age. “Warm hands off” is an excellent approach, but must be coupled with enhanced advocacy with criminal justice if coercive control is an ongoing problem. There are very limited gains in behavior/health so long as the abuse situation persists. Moreover, the warms hands off is too time consuming to work in a hospital or private office setting. A more effective approach has been the development of an independent case management professional who may be employed at a shelter, health center or police department and who is assigned to a family/case for up to 3 months after identifying and assessing their risk for abuse.
Every hospital in CT. should dedicate a full-time position to a domestic violence advocate who would be responsible for developing, implementing and monitoring site specific protocols.
The integration of screening into the CHC life-cycle model of care should be supported.
Control studies have failed to support the view that CBT is an effective treatment for trauma in general, let alone the form of diffuse trauma associated with exposure to coercive control.
Among the more effective approaches with children over 6 was an award-winning group program pioneered in conjunction with the CCADV, where a group of abused mothers and their children met separately for a 6 week period and then come together to share their perceptions and experiences. This approach is used widely in Europe and is still employed by the Coordinating Council for Children in Crisis (4-C’s) in New Haven.
The lead analogy is a very poor one. Questioning children about abuse in their home, a criminal offense, is not the same as questioning them about exposure to a toxin. Nor is there a simple test of such exposure. Moreover, while we test for lead because there are effective antidotes, we do not have a simple or agreed upon antidote for exposure to abuse.
The TF emphasizes the importance of screening for referral. While screening for child exposure may lead to referrals, another major function is to educate patients that abuse is a health concern and educate professionals about ‘clinical violence intervention,’ a way of practicing medicine in the context of abuse.
Any screening of children for exposure to abuse must be proceeded by informed consent of the parents, since there are definite risks involved of such discussion for children.
Policy and Procedure Recommendations:
1.1: Develop and employ policies that include research-supported, developmentally-sensitive and universal screening protocols in various pediatric healthcare settings to effectively identify children with direct and/or indirect exposure to IPV, as well as adversity, trauma, and maltreatment, which often co-occur with IPV.
Comment: Presumably there are already protocols for identifying maltreatment. Screening is important, but has been shown to make a difference (or even to be actually employed) only in conjunction with some supportive intervention, such as a referral to social work.
1.2: Develop and employ research-supported and universal screening protocols in prenatal health clinics, primary care, and obstetrics and gynecology to effectively identify women at risk for exposure to physical or psychological IPV during pregnancy, the first opportunity for IPV to affect children.
Comment: Hospitals are required to have such protocols at all sites as a matter of their continued licensure. The US Prevention Task Force and other medical groups, including WHO, have rejected universal screening because it has not shown to lead to any risk reduction. They have a point. Screening should occur, but only in conjunction with a well thought out, and ongoing, strategy of risk reduction. This point should be made strongly at the outset of the discussion of screening. (e.g. 1.3) A huge problem is that, apart from DCF, we really don’t have a network of wrap around services for families, except perhaps in the New Haven and Hartford areas, let alone such services for children apart from the Study Center, Clifford Beers, the Institute for Living, etc.…so a huge challenge s to broker/create the very services we hope to use as referral points. It would be a disaster if hospital social workers—now consumed by discharge planning—simply referred such cases to the ‘Dart’ team or to DCF directly. The Casey Initiatives adapted a ‘follow the dollar’ approach to case management, where managers had a sum to spend either by buying existing services or creating new ones. This is what is needed with exposed children.
Training
COMMENT This section includes a number of misconceptions about training. The worst is the victim-blaming suggestion that families work hard to hide partner abuse. There is not a shred of evidence to support this claim and it should be cut from the Report.
In fact, numerous studies show that, when asked, victims of abuse are forthright about their situation. Conversely, I and others have done studies showing that clinicians resist identifying abuse even when they have said they believe it is appropriate to do so and women disclose. The problems with disclosure have also revolved around the challenges posed by getting clinicians to ask. At present, most facilities utilize an online screening tool. But this tool is perfunctory.
Home visiting has been shown to reduce child abuse and facility women’s leaving abusive relationships, its effects quickly dissipate when the visitor relationship ends. This suggests the need for a more permanent or ongoing liaison.
Policy and Procedure: Policies that support screening, early identification, and cross-sector collaboration will allow for healthcare providers to engage in primary, secondary and tertiary prevention.
While Dr Grasso is right that children face polyvictimization in abusive homes, it is unclear where this leads, since inviting young children to discuss abuse in their homes is still quite controversial, particularly since we have no effective means to protect them or their mothers from the effects of such disclosure. If a pediatrician or other MD suspects coercive control, the best approach remains a discussion with the suspected target of abuse and, as trust builds, joint safety planning for or with the child if of proper age. “Warm hands off” is an excellent approach, but must be coupled with enhanced advocacy with criminal justice if coercive control is an ongoing problem. There are very limited gains in behavior/health so long as the abuse situation persists. Moreover, the warms hands off is too time consuming to work in a hospital or private office setting. A more effective approach has been the development of a case management professional who may be employed at a shelter, health center or police department and who is assigned to a family/case for up to 3 months after identifying and assessing their risk for abuse.
The integration of screening into the CHC life-cycle model of care should be supported.
Control studies have failed to support the view that CBT is an effective treatment for trauma in general, let alone the form of diffuse trauma associated with exposure to coercive control.
Among the more effective approaches with children over 6 was a group program pioneered in conjunction with the CCADV, where a group of abused mothers and their children meet separately for a 6 week period and then come together to share their perceptions and experiences.
Questioning children about abuse in their home, a criminal offense, is not the same as questioning them about lead. Nor are their diagnostic tests, as there are for lead poisioning, or assessment tools that are sufficiently robust to determine appropriate interventions with exposed children.
While screening for child exposure may lead to referrals. Its major function is integrate an understanding of the child’s experience/risks into ongoing care and to educate patients, their families and clinicians about the health significance of abuse.
Policy and Procedure Recommendations:
1.1: Develop and employ policies that include research-supported, developmentally-sensitive and universal screening protocols in various pediatric healthcare settings to effectively identify children with direct and/or indirect exposure to IPV, as well as adversity, trauma, and maltreatment, which often co-occur with IPV.
Comment: Presumably there are already protocols for identifying maltreatment. Screening is important, but has been shown to make a difference (or even to be actually employed) only in conjunction with some supportive intervention, such as a referral to social work.
1.2: Develop and employ research-supported and universal screening protocols in prenatal health clinics, primary care, and obstetrics and gynecology to effectively identify women at risk for exposure to physical or psychological IPV during pregnancy, the first opportunity for IPV to affect children.
Comment: Hospitals are required to have such protocols at all sites as a matter of their continued licensure. Again, though, the Prevention Task Force and other medical groups, including WHO, have rejected universal screening because it has not shown to lead to any risk reduction. They have a point. Screening should occur, but only in conjunction with a well thought out, and ongoing, strategy of risk reduction. I suggest that you make the point strongly at the outset (e.g. 1.3) that screening must be accompanied by effective assessment and referral mechanisms. A huge problem is that, apart from DCF, we really don’t have a strata of wrap around services for families, let alone children…so a huge challenge here is to broker/create the very services you hope to use as referral points. It would be a disaster if hospital social workers—now consumed by discharge planning—simply referred such cases to the ‘Dart’ team or to DCF directly.
1.3: When children are identified as IPV exposed, develop and employ protocols for effectively assessing needs and connecting them to resources that may include advocacy, social work, and psychological services.
1.4: Partner with co-located behavioral health care professionals trained to assess and treat psychological problems associated with children's exposure to IPV in order to optimize referral and connection to services.
1.5: Develop and implement protocols for establishing cross-sector collaboration between healthcare systems that screen for IPV and other child- and family-serving systems and agencies.
Training: Healthcare providers who receive training on IPV are more likely to screen for IPV. Training that identifies concrete strategies for healthcare providers to offer support to their patients also improves screening rates.
Comment: The suggestion that families work hard to hide partner abuse is misleading, not supported by a shred of evidence and victim blaming. It should be cut from the TFR. In fact, numerous studies show that, when asked, victims of abuse are forthright about their situation. Conversely, I and others have done studies showing that clinicians resist identifying abuse even when they have said they believe it is appropriate to do so and women disclose.
Again, while home visiting has been shown to reduce child abuse and facility women’s leaving abusive relationships, its effects quickly dissipate when the visitor relationship ends. This suggests the need for a more permanent or ongoing liaison.
Training Recommendations:
Comment: Add a requirement that a unit on how children are affected by exposure to coercive/control be added to the education of all health professionals in CT. as well as made a mandatory part of their continuing education.
Comment: The vast majority of children in CT. are seen in private practice. CCADV should restore Project S.A.F.E. (Safety Assessment for Everyone), a program in partnership with the CT. Medical Society that put appropriate literature in all medical offices, including literature on how abuse affects children.
Comment: The most effective approaches have involved saturating general patient areas with posters and literature about abuse, including exposure of children, and showing videos in waiting rooms.
Comment: Curriculum on domestic violence and coercive control should be a regular part of early childhood education in CT.
Comment: The high risk of pets and the degree to which harm to pets signals dv/coercive control suggests an important role for the Humane Society in preventing child exposure as well as a line of inquiry for pediatricians and other child health providers.
Comment: The TF should recognize that health personnel are often victims of abuse and that health institutions, like other workplaces, bear responsibility not only for their patients but also for their employees’ safety. The TF should extent its recommendations to educating all health workers re: the risks to themselves and their children and enhance safety practices, on site, for children as well as their parents.
Research Recommendation:
1.8: Partner with researchers in investigating the feasibility and effectiveness of screening and brief intervention protocols.
Comment: No more research is need on screening. We already have over 200 studies with data outlining how many questions, who they should be delivered, by whom, where, when and so on. This would be a waste of resources. Incidentally, none of these studies show a change in outcomes as a result of identification.
Outreach:
Comment: No one objects to more outreach. But it is simply wrong that many victims “normalize” abuse. There is no evidence to support this claim. It should be dropped as victim-blaming. However, there is compelling evidence that police, health providers, case workers and other professionals normalize abuse and quickly ‘learn’ to limit the resources they expend on ‘that type’ of family, use denigrating labels for these women and both trivialize and normalize their complaints. Thee approach to health providers in this report ignores the enormous resistance to identification and screening for abuse in the health system.
What is needed, and what has changed the game in Europe, is for providers and educational materials to name and describe the forms of abuse that go beyond violence, such as coercive control. First, though, we have to educate clinicians about these forms of abuse.
Successful strategies in Europe have included Poster contests in schools relating to dating violence and abuse; hotlines for teens; online tests to assess ‘control in my relationship,’ the development of a merit badge in the girl scouts in activism in general and stopping abuse in particular.
MDTs (multidisciplinary teams) and CACs (Children’s Advocacy Centers):
Comment: The expansion of MDTs to deal with child exposure is a terrible idea. Child exposure is not currently a crime and should not be criminalized. Courts, such as Bridgeport, which have tried to criminalize it have found it added nothing to their outcomes and only confounded case finding. So there is no point to putting child exposure on the agenda of a grp designed to investigate crimes. Even it were, it would quickly pale in importance next to “real” child abuse, and defeat our aim. While the MDT should be sensitized to the prevalence of coercive control as a context for CSA, it has no business dealing with child exposure, which is primarily an issue for social and mental health services, is almost certainly likely to blame mothers for exposure and has little or nothing to add to other resources. There is no need to forensically interview exposed children unless they have been physically or sexually abused and we already have sufficient protocols in place to investigate and prosecute these harms. Adding another layer of bureaucracy and intrusion into children’s lives can do nothing but further traumatize children and frighten their moms, further inhibiting reporting.
2. LAW ENFORCEMENT
Comment: While some of these models of trauma intervention are helpful to some children, as I pointed out in the introduction, most exposed children are neither depressed nor traumatized. In any case, unless the source of ongoing harm is removed, the stress exposure continues. Police should not be playing the role of social workers.
Proposal: CT. should develop a corps of professionals, let’s call them Domestic Abuse Advocates (DAA) who would be contacted by police in cases deemed high risk, particularly those which children as well as their mothers are deemed in danger. The DAA would be employed by a community agency, shelter, health center, police department or DCF office, the agency would bid the position, and the DAA would act as a support and case manager for the family for up to three months. The DAA would report to a regional supervisor. Most countries and many states have systems like the DAA. NJ’s system of Crisis Response Teams that respond to homes after a police visit is built around community volunters. England’s IDVA’s (Independent Domestic Violence Advisors) Evaluations find that involvement of such personnel significantly reduces repeat calls, facilitates permanent separation and protects children. The system works best when the DAA is housed in a woman friendly agency like a shelter, but not only.
The assignment of a DAA function assumes police in CT. devise a science-based means to assess risk. One way to do this is simply to identify cases where there have been repeat calls in the last 6 months as high risk. I discuss this issue elsewhere.
Background on Connecticut’s Family Violence Laws:
Comment: This recommendation is based on the mistaken belief that exposure is an episode specific event rather than issue of chronic exposure requiring ongoing support for the victim and child. My objection here is not to coordination, but the idea that there needs to be a ‘coordinated response at the scene.’ At best, this approach takes the key decision making out of the hands of a victimized mother who already feels disempowered by the batterer. At worst, it creates added tension between mother and child and reinforces that child’s belief that the abuse is his/her fault.
Reporting:
Comment: Police Response at the Scene What should happen at the scene is that police should be mandated to take a picture, administer an assessment tool, conduct a proper interview to establish the history of abuse, gather evidence and write a narrative supported by any observations. We think of it as “opening a window.” Once the officer makes a preliminary assessment of risk to the woman and/or child in the home, s/he takes one of three steps:
If a case is deemed high risk, the officer should put the woman in touch with the DA and report the case to a supervisor. If no arrest is made at the scene, the officer should then initiative a background check of the offender, assessing him from every angle, including unpaid tickets, outstanding warrants, registered and unregistered firearms, abuse of previous partners, etc. Reports of child exposure should be in the overall context of abuse.
If a case is judged standard risk, the officer should encourage the victim to contact a shelter or other community-based services and review how the woman plans to keep herself and her children safe in case of a repeat assault.
In cases deemed low risk, where no arrest is indicated, the officer should provide the victim with information about available help, inform her about his concerns, including concerns for the children, and assure her she can call whenever she believes she is in danger.
As indicated, the notion of ‘child witnesses’ as an important prism to understand coercive control is out of date and affords little or no helpful information.
Policy Recommendations:
2.4: COMMENT: These are terrible ideas. Every state that has adapted a similar approach to police liaison with DCF (except where there is manifest abuse) has rejected it. It has flooded CPS with inappropriate referrals, done nothing to help the children, created a system of labelling that leads to a range of harmful outcomes for all concerned. Police have no business playing this role and are not equipped to do so.
EARLY CHILDHOOD
These Recommendations are Uncontroversial and should be supported.
EDUCATION/TEEN DATING VIOLENCE
Comment: The evidence re: these programs is that the overall school culture/climate has far more to do with low levels of bullying and dating violence in the school that specific safe date curricula.
Since many children who are bullied are perceived as ‘different,’ gay or transgendered or foreign-born, it is imperative that such programs include strong support for minority and marginalized students
On the other hand, a very effective approach has been to identify “school champions,” teachers who have taken the lead in incorporating curricula on anti-abuse
Comment: As pointed out earlier, the singular lack of a gender focus in these proposals makes them ineffective as a way to combat partner abuse among young people.
Comment: The most effective interventions have employed online tests and meeting sites where children can talk to one another, almost always off campus or in chat rooms—these sites may be loosely monitored for stalking—and reach out for expert help if they want it. These sites can address many of the issues, such as sexting, that schools have been reluctant to address yet which are at the heart of coercive control among teens.
1. JUDICIAL
Comment: The Greenbook was quite progressive when it was introduced; it is very out of date as a model of reform.
Comment: Judicial training on domestic violence should be mandatory, annual and required as a condition of staying on the bench. New Jersey is a good example of this sort of mandate.
Comment: The best judicial trainings are not didactic but interactive and there are numerous curricula around that involve judges directly in simulated decision-making. These are far more effective that ‘evidence-based’ material presentations (though those help as well). The TF should recommend scanning and adapting interactive training models.
Comment: No amount of judicial training will change practice unless and until family court judges are accountable for hearing domestic violence evidence and explaining why, if they don’t rely on it in their orders, they have not done so.. The best way to do this appears to be the Colorado model described in the introduction. My understanding from talking to the head of the Colorado Coalition is that implementation of the new court requirements in domestic violence cases has reduced complaints from mothers alleging abuse to near zero.
Develop a child registry
COMMENT: This is a terrible idea. It is almost certainly unconstitutional, raises the spectre of all sorts of abuses and violates the most basic human rights of children to privacy. It puts incredible extra-judicial power in the hands of the judiciary and potentially allows ‘evidence’ in cases other than the evidence provided by the parties. No reason is given why such a registry would improve child safety and certainly no compelling reason that would override our concerns. The potential for misuse or perceived misuse of such a registry are enormous. While it is not designed to be punitive, it most definitely will be seen as such and could inhibit childrens’ participation in court proceedings.
PROBATE COURT
COMMENT: THERE IS A CRITICAL NEED FOR GREATER COMMUNICATION BETWEEN THE VARIOUS COURTS ON FAMILY VIOLENCE CASES. I have had a number of clients who were ordered to allow no contact by a Probate Court or a criminal proceeding and told they would lose custody if they refused to provide contact by the Family Court. Moreover, many family cases list domestic violence as only “alleged” when there is a long history of OP and criminal case findings. A priority should be placed on ensuring that civil and criminal OP are included in the family file.
CHILD WELFARE
Comment: I have outlined my objections to greater involvement of DCF in partner abuse cases throughout. However much we would like this to change, low-income, minority and many other mothers do not have a positive view of DCF (to put it kindly) and see any interaction, no matter how well intentioned, as punitive, particularly with the spectre of removal hanging in the air.
It is too early to evaluate the Department’s current initiatives. However, I can say unequivocally that DCF appears to be moving away from the type of victim/child empowerment, offender accountability Family First Model towards a model that emphasizes family-based supports and interventions. If this is so, it will make things worse for abused clients and exposed children, not better. The victim blaming practices of the past will be resurrected and abuse will once again dissolve back into the morass of family problems DCF confronts daily in its low-income, minority and multi-problem caseload.
The TF should urge DCF to ensure that all programs adhere to the principles of the S&T model, namely working with victims from a strength perspective that audits and reinforces the steps they are already taking to keep their children safe and holds perpetrators solely and completely responsible for any abuse.
As I indicate earlier, I have no objection in principle to family preservation type strategies which combine education for fathering with in-home supports. But the two caveats are critical. Historically, the needs of many abused clients have fallen between the cracks of the services DCF offers, particularly the needs for employment, job training, continuing education, health insurance, inexpensive child care and housing. The second caveat is that home-based, family preservation type programs are inappropriate and potentially life-threatening for women and children subjected to coercive control. Since this population comprises the largest proportion of abuse victims, without an science-based assessment scheme based in a careful review of perpetrator histories, programs such as those described here are counter-productive. This is why NYC recently considered and rejected this model.
Child Witness to Violence Project
Comment: This is an excellent program and should be supported.
Comment: Bystander education is increasingly being used by school systems to comba bullying and dating violence. While evaluations are mixed, it is worth looking at seriously. It has only recently been extended to helping mothers negotiate for the safety of their children in abusive homes. There is no evidence as yet that it is effective, though it may be.
Mandated Reporter Recommendations:
COMMENT: MANDATING REPORTING OF CHILDREN EXPOSED TO ABUSE IS A TERRIBLE IDEA, FOR ALL THE REASONS GIVEN IN THE INTRODUCTION, NAMELY THE SITUATION IS NOT EMERGENT, THAT DCF INVOLVEMENT IS RARELY REQUIRED, THAT REPORTING WILL BE BIASED AGAINST LOW INCOME AND MINORITY CHILDREN, THAT THERE IS NO EVIDENCE THAT DCF HAS ADDITIONAL RESOURCES TO PROTECT THE MOTHERS AND CHILDREN IN THESE CASES OTHER THAN THOSE ALREADY AVAILABLE FROM OTHER SOURCES, THAT SUCH REPORTING CREATES AN ADMINISTRATIVE NIGHTMARE BECAUSE >80% OF THE EXPOSED CHILDREN DO NOT REQUIRE SERVICES, THAT, AS A RESULT OF THE OVERWHELMING PROPORTION OF ‘FALSE POSITIVES,’ VITAL DCF RESOURCES WILL BE REDIRECTED FROM MORE NEEDY CHILDREN AND BECAUSE OF THE RANGE OF THREATS, STIGMA AND INHIBITING FACTORS ASSOCIATED WITH ANY DCF REPORT. IN ADDITION, A WIDELY IDENTIFIED ELEMENT OF COERCIVE CONTROL INVOLVES THE ABUSER’S THREATS TO REPORT THE MOTHER TO DCF. BY MANDATING REPORTING OF CHILD EXPOSURE, WE REINFORCE THE ABUSER’S THREATS. THESE PROBLEMS GREATLY OUTWEIGH ANY POTENTIAL BENEFITS FROM EXPANDING MANDATORY REPORTING.
MODEL POLICY
I HAVE OUTLINED MUCH OF WHAT I BELIEVE IS NEEDED TO BETTER PROTECT OUR CHILDREN EXPOSED TO ABUSE. In sum, a model policy would:
1. Identify protecting non-offending mothers as one of the two most important ways to protect children from the effects of exposure;
2. Identify early interdiction and effective prosecution of offenders as one of the two most important steps to protecting children from abuse exposure;
3. Broaden all definitions of domestic violence to include coercive control. Adapt training and public education materials accordingly, including those referring to child harms.
4. Enact a new offense of domestic violence and coercive control that reflects the real nature of the oppression to which abused women and their children are exposed.
5. Mandate annual training for CT. judges in domestic violence, coercive control and how they affect children;
6. Replace the Guardian system with a system of ‘lawyers for children;
7. Require that any evaluation in custody cases involving allegations of abuse be conducted by mental health professionals with this expertise; conversely, prohibit evaluations in abuse cases by person who lack specialized training in how it effects children;
8. Reform the reception of domestic violence allegations in family court. To wit:
a. Incorporate into law the US House of Representative Recommendation that presumption of custody should be given to victims of domestic violence;
b. Add “safety” to the “child’s best interest” as an explicit goal of court orders in disputed custody cases;
c. Order that a full hearing be given to domestic violence allegations in family court prior to the presentation of the case-in-chief;
d. Prohibit sanctions for mothers who violate court orders re: providing access when these violations involve a reasonable belief that such access would put them and their children at risk. allegations of domestic violence be fully heard and that evidence of domestic violence play a major role in court orders re: custody and child support;
9. Reform the reception of domestic violence and coercive control by police, to wit:
a. Implement a science-based risk assessment that allows police to identify high risk offenders;
b. Enhance police training to include coercive control
c. Utilize police as liaisons to a new corps of case management professionals.
10. Create and fund a new corps of case managers who provide support and assess and help to negotiate to meet the needs of abused women and their children in cases deemed high risk. The Domestic Abuse Advisors (or Advocates) be housed at various community agencies based on a competitive bidding process and will be supervised by regional coordinators.
11. Broaden the conditions for Orders of Protection to extend their coverage to coercive control and provide for greater accountability over their issuance. These steps would save dozens of children’s lives annually in our State.
12. Adapt a “Abuse Prevention Agenda” that includes a mandate that all public schools develop gender-based, anti-violence, anti-abuse curricula;
13. Develop a system to recognize “champions” of abuse prevention in schools, health systems and other institutions responding to partner abuse and child exposure;
14. Require all professional education programs to include units on woman abuse, coercive control and its effects on children, particularly those who will work with children or women in any capacity.
15. Develop and support a PSA initiative that communicates the nature of coercive control and the risks it poses to children
I respectfully submit these comments. January 6, 2016
Evan Stark, Ph.D, MSW
11 Forest Trail, Woodbridge, CT. 06525
203-393-5515
eds203@juno.com
