Patricia K.
Kerig and Anne E. Fedorowicz, “Assessing Maltreatment of Children of Battered
Women: Methodological and Ethical Considerations” 4 Child Maltreatment
103 (1999).
in children
of battered women and offers guidelines to improve research
and practice
in the field. Methodological problems regarding the measurement
of child maltreatment
experiences are discussed. Next, techniques appropriate
for assessing
maltreatment of children of battered women are reviewed,
including parent
questionnaires and interviews, children's reports, case
record reviews,
and observations. In addition, ethical concerns are addressed,
particularly
regarding the consequences to battered women when investigators
are required
to breach confidentiality and report suspected maltreatment
to child protection
authorities. Practical suggestions are offered regarding
how these problems
might be resolved.
In recent years,
significant attention has been drawn to the negative effects
on children
of exposure to their mothers' abuse (for recent reviews, see
Geffner, Jaffe,
& Sudermann, in press). Moreover, children who witness
violence in
the home are at increased risk for being abused themselves.
For example,
Straus, Gelles, and Steinmetz (1980) report that woman battering
and child abuse
co-occur in 40% to 60% of families and Layzer, Goodson,
and DeLange
(1986) found that almost 70% of children entering battered
women's shelters
had also been maltreated. Children who are both witnesses
to and victims
of violence in the home demonstrate more severe maladjustment
than children
who are not also abused (Hughes, Parkinson, & Vargo, 1989;
Jouriles &
Norwood, 1995; McCloskey, Figueredo, & Koss, 1995; O'Keefe,
1995). Given
this, it is important to assess the extent of both exposure
to violence
and child maltreatment so that we can understand and differentiate
their effects.
However, there
are a number of issues that complicate this area of research.
First, there
are methodological problems regarding the measurement of child
maltreatment
experiences. Second, important ethical concerns are raised
by the assessment
of maltreatment in children of battered women, particularly
when investigators
must breach confidentiality and report data gathered
during the
research process to child protection authorities. The purpose
of this article
is to review the considerations to be made in the assessment
of child maltreatment
in children of battered women and to suggest practical
solutions to
facilitate research and practice.
METHODOLOGICAL
ISSUES
What Constitutes
Maltreatment for
Children of
Batted Women?
First, it is
important to note that no universally accepted definition
of child maltreatment
exists in the maltreatment literature (see Socolar,
Runyan, &
Amaya-Jackson, 1995). Therefore, any attempt to assess child
maltreatment
must struggle to catch hold of a slippery concept. However,
progress has
been made in developing typologies of the kinds of abuse experienced
by children.
For example, Barnett, Manly, and Cicchetti (1993) developed
a comprehensive
taxonomy of maltreatment, which includes neglect, as well
as physical,
sexual, moral/legal/educational, and psychological maltreatment.
Barnett et
al.'s system includes exposure to violence in the category of
psychological
maltreatment, as do others (e.g., Hart, Binggeli, & Brassard,
1998). However,
there are both benefits and problems arising from defining
exposure to
woman abuse as a form of psychological maltreatment. On the
positive side,
this definition states that exposure to violence is a form
of maltreatment,
thereby increasing the leverage that police and social
welfare agencies
have to intervene to protect the children. On the negative
side, defining
exposure to violence as a form of psychological abuse presents
a dilemma,
particularly for researchers concerned with differentiating
the effects
of witnessing versus being a target of abuse. If exposure to
woman abuse
is a form of child maltreatment, the two variables are confounded.
Last, the definition
of psychological maltreatment is still subject to
debate (see
McGee & Wolfe, 1991), and it is therefore not assessed in the
same way-if
it is assessed at all-from study to study.
In sum, the
lack of clear and commonly accepted definitions of maltreatment
hinders our
ability to understand and differentiate its effects on children
of battered
women. Thus, it is essential that practitioners and researchers
continue to
collaborate in our efforts to define and assess child maltreatment.
A consensus
may be difficult to achieve regarding the conceptualization
of such complex
constructs as psychological maltreatment. One step in the
direction of
consensus building is the series of the International Conferences
on Children
Exposed to Violence, bringing together researchers, policy
makers, child
advocacy workers, and the battered women's support community
to share perspectives
on the problems of understanding and intervening
in violence
in the home.
The developmental
psychopathology perspective. Cicchetti and Toth (1995)
argue that
to define maltreatment, it is necessary to place it in a developmental
context. This
requires attending to the needs children have at each stage
of development
as well as the potential for harm inherent in a parent's
failure to
meet those needs. Consideration must be given to the child's
age, stage-salient
tasks, and the developmental processes that might be
disrupted by
various kinds of maltreatment.
In the case
of children of battered women, the developmental impact of
abuse may vary
depending on who is the perpetrator. Although few data are
available that
speak to this issue, there may be different contributions
made by mothers
and fathers to children's development. For example, when
the perpetrator
of child abuse is the abusive male partner, children may
take from this
experience the lessons that male violence is normative and
that "might
makes right" in relationships (Kerig, in press). This, in turn,
may further
increase the likelihood that children will perpetuate the cycle
of violence
by behaving aggressively toward peers (Graham-Bermann & Levendosky,
1998) and romantic
partners (Wolfe, Wekerle, Reitzel-Jaffe, & Lefebvre,
1998) . In
contrast, when violence in the marriage spills over onto the
motherchild
relationship, the key effects may revolve around issues of
attachment
and emotional insecurity (Cummings, 1997), leading to internalizing
symptoms such
as anxiety, depression, and self-blame.
Furthermore,
developmental differences may exist regarding the other kinds
of maltreatment
experiences for which child witnesses of woman abuse are
at risk. For
example, for young children, the helplessness, confusion,
and terror
of witnessing woman assault may make the experience a particularly
psychologically
abusive one. In contrast, older children may be especially
at risk for
physical abuse should they attempt to intervene during interparental
violence (Jaffe,
Wolfe, & Wilson, 1990).
In sum, although
more questions arise than the available literature can
answer, the
developmental psychopathology perspective points us toward
the kinds of
questions that need to be asked to understand the effects
of child maltreatment
in battered women.
How Should
Maltreatment Be Measured?
In addition
to the dilemmas described above regarding how to define child
abuse, the
state of the art does not yet provide us with an agreed-on methodology
for assessing
different forms of maltreatment. Various assessment techniques
have been used,
including parent and child self-report measures, interviews,
and reviews
of social service agency records. Often, no standardized measure
is used. Moreover,
seldom are data obtained from more than one informant,
making it difficult
to assess reliability or validity of reports (Fantuzzo
& Lindquist,
1989) . In addition, because no commonly used measure exists,
abuse is defined
differently from study to study, making it difficult to
compare across
samples to expand our understanding of the correlates, causes,
and consequences
of child maltreatment (Gelles, 1990). Furthermore, not
all measures
used have established psychometric properties, and many are
limited in
their comprehensiveness and sensitivity to developmental issues
related to
the abuse of children.
Categorical
versus continuous ratings. A general methodological issue that
must be addressed
is whether child maltreatment should be measured categorically
(abused/not
abused) or whether continuous ratings should be obtained. Most
of the literature
relies on categorical systems; however, this method results
in the loss
of much information as well as statistical power. Moreover,
efforts to
classify children's abuse experiences as one type or another
do not reflect
the reality of growing up in an atmosphere of violence,
where multiple
victimization is the norm (Briere, 1992; O'Keefe, 1995).
Therefore,
advancement of the field requires that investigators index all
forms of maltreatment
that children might have experienced.
The assessment
of multiple forms of maltreatment has been considered problematic
from the standpoint
of data analysis, because the numerous permutations
that result
(e.g., physical, sexual, physical/sexual, physical/sexual/psychological,
etc.) require
an impossibly large number of participants to fill each "cell"
(Kinard, 1994).
However, the problem is the attempt to categorize child
abuse, when
abuse itself is not a discrete variable (Mash & Wolfe, 1991
) . An alternative
is to rate maltreatment a continuous variable, based
on frequency
and severity, and to use multivariate statistical designs
to assess the
relative independent and combined effects of different forms
of abuse (see
Wolfe & McGee, 1994). Although it might seem to make for
more complex
data, only by rating multiple dimensions of maltreatment simultaneously
will we be
able to understand their implications for children's development.
Next, we turn
to a review of the available methods for assessing maltreatment.
Case Record
Data
A frequently
used method of assessing child abuse requires the investigator
to code data
from records such as those kept by social service agencies.
This usually
takes the form of categorically indexing whether or not a
report to child
protection services has been substantiated. Most often,
this is done
for physical abuse only (e.g., Jaffe, Wolfe, Wilson, & Slusczarzck,
1986) but sometimes
for other forms of maltreatment as well (e.g., Hennessy,
Rabideau, Cicchetti,
& Cummings, 1994).
A more differentiated
system for coding child protective services reports
was developed
by Barnett et al. ( 1993) . Their system rates the severity
of physical,
sexual, emotional, and moral/legal/educational maltreatment,
as well as
neglect. Each form of abuse is given a rating on a 5-point scale,
ranging from
minor to severe, based on the perceived consequences to the
child. For
instance, physical acts resulting in minor marks on a child's
body receive
a rating of 1, and injuries requiring hospitalization a 5.
In addition,
this system assesses frequency, chronicity, perpetrators,
the developmental
period in which they took place, and the child's history
of separations
from primary caregivers. Strengths of this coding system
include that
it is comprehensive and well-defined, with codes anchored
by concrete
examples, and that good interrater reliabilities have been
established
(Manly, Cicchetti, & Barnett, 1994). However, no studies to
date have used
this measure specifically with children of battered women.
A second system
for coding children's abuse experiences dimensionally from
case record
data was developed by McGee, Wolfe, and Wilson ( 1990) . The
Record of Maltreatment
Experiences (ROME) is designed to provide a comprehensive
assessment
of the child's history of victimization. Items are rated according
to frequency
(rarely, sometimes, or often) and severity (mild, moderate,
or severe)
for three age periods (birth to 6 years old, 7 to 12 years old,
and 13 to 16
years old). Data regarding the reliability and factor structure
of the ROME
were obtained from a review of the records of 162 adolescents
receiving services
from child protection agencies (Wolfe & McGee, 1994).
Factor analysis
revealed that the items fell into seven scales: psychological
abuse, neglect,
physical abuse, serious threats/assaults, partner abuse
(exposure to
woman battering), violence/destruction, and positive childrearing.
A sexual abuse
scale was also added. Different forms of abuse were found
to have unique
and additive effects on adolescent adjustment, attesting
to the utility
of the measure. The availability of a rating of exposure
to woman abuse
independent of other forms of maltreatment makes this measure
uniquely appropriate
for those concerned with assessing children of battered
women.
Limitations
of case record data. One of the greatest strengths of coding
systems such
as ROME is also one of their most significant limitations:
They are based
on a review of social service records. On the positive side,
social service
agency records provide a source of information that is not
as vulnerable
to defensive or socially desirable responding as are parent
and child reports.
However, most researchers studying children in battered
women's shelters
do not have access to such documentation. Maternal and
child reports,
therefore, are often the only available sources of information.
In addition,
social service agency records are not kept systematically,
nor with the
investigators' coding system in mind, and thus do not always
provide information
that is complete or accurate (Cicchetti & Olsen, 1990).
Information
regarding nonphysical forms of maltreatment, such as psychological
maltreatment
or exposure to woman abuse, is often absent from these records
(Manly et al.,
1994; McGee, Wolfe, Yuen, Wilson, & Carnochan, 1995).
Moreover, although
such records may appear to provide objective and reliable
sources of
information, this is not necessarily the case. Different caseworkers
may use discrepant
criteria in deciding whether or not to make a report
to child protective
services-perhaps based on the particular legal criteria
in their jurisdictions-thus
reducing comparability of data derived from
various studies.
It is also probable that much child abuse goes unreported,
and therefore
study results will be based on a small and unrepresentative
sample (Cicchetti
& Olsen, 1990). Furthermore, racial and social class
biases in child
abuse reporting and substantiation of reports have been
detected (Scott-Jones,
1994). Last, because forms of maltreatment are not
well-defined,
the same parent behavior might be labeled differently by
different case
workers (Kinard, 1994). In particular, exposure to violence
may be considered
a form of child abuse in one locality but not in another.
Thus, there
are many ways in which these data may be of limited utility
for the study
of children of battered women.
Case Worker
Reports
Less frequently,
child protection workers are asked to complete interviews
or questionnaires.
This method can only be applied when a case worker has
been involved
with a family to a significant extent. For example, Sternberg,
Lamb, and Dawud-Nousi
(1997) asked social workers to complete a 50-item
questionnaire
regarding the history of maltreatment experienced by children
in their caseloads.
Even workers who had had extensive contact with families
were unable
to answer many of the questions. In their follow-up studies,
Sternberg et
al. decided to obtain family members' own reports on violence
in the home.
Parent Reports
Parent-report
questionnaires. One of the most commonly used parent-report
measures is
the Conflict Tactics Scale (CTS) (Straus, 1979), which has
been used to
obtain mothers' ratings of child physical abuse in a number
of studies
of children of battered women (Holden & Ritchie, 1991; Jouriles
& LeCompte,
1991; Jouriles & Norwood, 1995; Kruttschnitt & Dornfeld, 1993;
O'Keefe, 1994,
1995; Wagner & Rodway,1995). Although all of these studies
obtained ratings
of both mother-to-child and father-to-child aggression,
these were
obtained from one parent only, specifically the mother in all
but one case.
Jouriles, Mehta, McDonald, and Francis (1997) obtained reports
from both parents
but found only modest agreement between them.
Benefits of
the CTS include that it offers concrete categories of frequency
that are intuitively
accessible (e.g., once a week), that it has national
norms, and
that it is widely used, thus allowing comparison across studies.
A major limitation
of the original CTS was that it was not comprehensive
in assessing
different forms of maltreatment. Many investigators coped
by modifying
the instrument; for example, McCloskey et al. (1995) added
questions to
obtain parental reports of verbal, physical, sexual, and escalated
abuse (lifethreatening
violence). However, the psychometric properties
of these modified
forms are seldom assessed, and the norms provided by
the original
are unavailable.
Fortunately,
the CTS has been revised recently in ways that offer a number
of improvements.
The CTS-2 (Straus, Hamby, Boney-McCoy, & Sugarman, 1996)
was developed
specifically for adult-adult abuse, whereas a parent-child
version (CTSPC)
(Straus, Hamby, Finkelhor, Moore, & Runyan, 1998) was developed
specific to
child abuse. The CTSPC includes new items assessing neglect,
sexual abuse,
psychological aggression, physical assault, and nonviolent
discipline
methods. Psychometric data were obtained through telephone interviews
of a nationally
representative sample of 1,000 U.S. children, with low
to moderate
reliabilities. Another benefit of the revision is its brevity,
requiring only
6 to 8 minutes for administration. In addition, the new
versions feature
the random ordering of items, which is of particular interest
given that
Fisher and Eddy (1993) found that mothers were more likely to
acknowledge
negative parenting techniques when these items were interspersed
with more positive
options on a paper-andpencil questionnaire. However,
like its predecessor,
the CTSPC does not take into account the context,
antecedents,
or consequences of an act when perpetrated against children
of different
ages (Fantuzzo & Lindquist,1989).
Parent interviews.
An alternative to obtaining questionnaire data is to
seek information
from parents via interview. Sometimes, parent reports
are obtained
in an unstructured way through unspecified questions (e.g.,
Spaccarelli,
Sandler, & Roosa,1994), which can be compared to reports from
shelter staff
for verification (e.g., Hughes et al., 1989). However, a
better method
is the semistructured interview technique, which can enhance
the accuracy
and recall of retrospective reports (Brewin, Andrews, & Gotlib,
1993). For
example, follow-up questions have been found to uncover abuse
experiences
that are not endorsed on questionnaires (Peters, Wyatt, & Finkelhor,
1986). Semistructured
interviews also avoid inaccuracy and reporting biases
by inquiring
about objective behavior, which can be subsequently typologized
by the investigator,
instead of requiring respondents to make those judgments
(Bifulco, Brown,
& Harris, 1994). Other advantages to interviews include
that they do
not require functional literacy and that they provide the
investigator
the opportunity to set the interviewee at ease and to explain
questions to
obtain more valid answers (e.g., Fedorowicz & Kerig, 1996).
The CTS was
originally administered as part of a structured interview,
both in person
and over the telephone. Gelles (1990) recommends the use
of telephone
interviewing for the study of sensitive topics such as family
violence, given
that greater privacy and candor are afforded with no apparent
cost to reliability
and validity (Lawrence, Heyman, & O'Leary, 1995) .
This technique
has been used to good effect in studies of battered women
(O'Neill &
Kerig, 1996).
Given the limitations
of the CTS noted above, it would be desirable to
have an alternative
interview measure more suited to the study of maltreatment
in children
of battered women. Again, no commonly used interview is available,
and most of
those used do not provide data on reliability or validity.
One semistructured
interview that could be adapted for parent reports is
the Childhood
Trauma Interview (CTI; Fink, Bernstein, Handelsman, Foote,
& Lovejoy,
1995), which was designed to assess retrospective accounts of
childhood separations/losses,
physical neglect, emotional abuse, physical
abuse, witnessing
violence, and sexual abuse. The authors report high interrater
reliabilities
and evidence for validity. Again, further work would be needed
to evaluate
the utility of this measure for obtaining parental reports
of child maltreatment.
Limitations
of parent reports. Response bias is an important concern when
information
about abuse is based solely on parent reports. Parents' reports
of child maltreatment
may provide significant underestimates (Kolko, Kazdin,
& Day,1996),
whether because of shame, denial, fear of legal consequences
(Cicchetti
& Olsen,1990), or simple memory deficits due to the passage
of time (McGee
et al.,1995). However, in the case of battered women, another
consideration
is the fact that these are traumatized people who may be
in a state
of distress that limits their ability to participate in any
form of data
collection. Furthermore, battered women may demonstrate symptoms
of PTSD (Devoe
& Graham-Bermann,1997), including denial and numbing, dissociation,
and memory
distortions, which can hinder the accurate recall of information
(Briere, 1992).
Child Reports
Less frequently,
researchers elicit children's own reports of their maltreatment
experiences.
Obtaining information from children is consistent with the
perspective
of the two leading models of the effects of interparental discord
on children.
Both Grych and Fincham's (1990) cognitive contextual model
and Davies
and Cummings's (1994) emotional security hypothesis emphasize
the importance
of understanding the child's-eye view of the family, as
children's
appraisals of the meaning and implications of the violence influence
their reactions
to it (Kerig, 1998). Children's own reports of abuse provide
unique information
predictive of their functioning (Kolko et al., 1996;
McGee, Wolfe,
& Wilson,1997) and, in some circumstances, may be more informative
than parents'
reports (Richters & Martinez, 1993).
The CTS has
been used in a structured interview format to obtain reports
of maltreatment
from school-age children of battered women, with some success
(Osborne &
Fincham,1996) . Evidence of the validity of child reports usually
comes from
comparisons to parent reports. Jouriles and Norwood (1995) found
that mothers'
and children's reports of physical aggression corresponded
fairly well,
with correlations ranging from .30 to .50. However, Jouriles
et al. (1997)
reported low convergent validity for ratings of parent-to-child
aggression
obtained from mothers, fathers, and children from 7 to 9 years
old. Similarly,
Kolko et al. (1996) compared CTS data received from children
ages 6 to 13
years old and their mothers, finding low-to-moderate correspondence.
In particular,
whereas children's overall ratings of most forms of family
violence were
low, they reported three times more mother-to-child violence
than did mothers.
However, there
are two significant limitations of the CTS for obtaining
reports of
maltreatment from children of battered women. First, as noted
above, the
original CTS was not comprehensive regarding different forms
of maltreatment,
requiring extensive modifications to meet the needs of
investigators
(e.g, McCloskey et al., 1995). The new CTSPC may effectively
deal with the
problem of comprehensiveness. However, the second problem
is that neither
the CTS nor the new CTSPC were designed for use with children.
Thus, they
may require comprehension skills that limit their appropriateness.
For example,
Jouriles and Norwood (1995) found that children younger than
8 years old
had difficulty understanding the CTS.
A new comprehensive
structured interview has recently been developed for
use with adolescents,
the Ratings of Past Life Events Scale (ROPLES; McGee,
1990). The
ROPLES assesses the severity of physical, sexual, and psychological
abuse, as well
as neglect and exposure to family violence. The authors
report adequate
test-retest reliabilities from a sample of 33 adolescents
and have used
the scale to good effect in research (McGee et al., 1997)
. Modification
might be needed to make the scale appropriate for pre-teenage
children.
McGee and colleagues
(1997) also developed a self-report version of the
ROME, the Family
Background Questionnaire, which has been used with university
undergraduates
to rate frequencies of physical, sexual, and psychological
abuse, as well
as physical neglect, psychological neglect, exposure to
family violence,
and constructive parenting. Also indexed is whether the
perpetrator
was the mother, father, or another adult. Fair-to-excellent
internal consistencies
of these scales are reported by the authors. Again,
however, this
measure is designed for adults, and so far limited psychometric
information
is available.
Alternatively,
the Child Abuse and Trauma Scale (CATS) (Sanders & Becker-Lausen,
1995) has been
used with adolescents to obtain reports of physical, sexual,
and emotional
abuse. Advantages of the CATS include coverage of several
dimensions
of abuse appropriate to children, as well as good psychometric
properties.
In addition, care was taken to avoid social desirability and
response sets
in the wording and scoring of items. Although it has not
been extended
downward for use with younger children, the attempt might
be fruitful.
Limitations
of child reports. As this review of the literature reveals,
there is no
comprehensive and psychometrically proven measure available
for obtaining
multidimensional ratings of maltreatment from preadolescent
children. This
is unfortunate, not only because reports from multiple family
members' perspectives
would allow us to avoid mono-informant bias (Fantuzzo
& Lindquist,
1989; Mash & Wolfe, 1991) but also because children have a
unique perspective
on the family system, and their voices too often go
unheard.
Furthermore,
interviewing children requires special considerations and
skills-both
to obtain reliable and valid data and to avoid discomforting
them. Although
some have questioned whether credible self-reports can be
obtained from
young children, evidence shows that when due attention is
given to the
language comprehension and cognitive skills of children, as
well as their
needs for appropriate structure and emotional support, reliable
and valid information
can be obtained (Amato & Ochiltree, 1987; Garbarino,
Stott, et al.,
1992; Lamb, Sternberg, & Esplin, 1994; Mash & Wolfe, 1991;
Steward, Bussey,
Goodman, & Saywitz, 1993).
For example,
a thoughtful set of procedures for interviewing children about
witnessing
and experiencing violence in the home was developed by Sullivan,
Juras, Gauthier,
Nguyen, and Prewitt (1996). These investigators paid careful
attention to
wording questions and response categories in developmentally
appropriate
language, providing concrete referents for behaviors and the
passage of
time (e.g., "since school began"), normalizing children's experiences
and responding
empathetically but calmly to disclosures, and allowing children
the option
of pointing or using props such as "thermometers" to indicate
their responses
so as to lessen their discomfort with providing sensitive
information.
Sullivan et al.'s guidelines offer a significant contribution
toward the
development of measures that are sensitive to the needs of children.
In sum, it
is possible to create valid and psychometrically sound techniques
for obtaining
even young children's self-reports, as evidenced by the wellestablished
measures designed
to tap such sensitive issues as family discord and interparental
violence. Research
on children's reports of maltreatment has not yet benefited
from the same
attention to developmental considerations.
A general limitation
of all self-report measures is that they are vulnerable
to response
biases. Caveats about obtaining children's reports include
that they have
been found to minimize the amount of abuse they have experienced
(Jouriles et
al., 1997) and to underestimate its impact (McGee et al.,
1995). Children
may also fail to disclose because of a family "code of
secrecy"
or feelings of loyalty to the abusive parent, especially when
they are still
living in the violent home (Jaffe, Sudermann, & Reitzel,
1992). Furthermore,
just as with adults, PTSD symptoms can be a hindrance
to the accurate
recall of traumatic experiences by children. This is of
particular
concern in the study of children of battered women, as there
is strong evidence
for the prevalence of PTSD in this population (DeVoe
& Graham-Bermann,
1997; Rossman & Ho, in press) .
Furthermore,
some have expressed concern that adults and children may be
discomforted
by questions regarding abuse and may even refuse to participate
if such issues
are broached (Barnett et al., 1993). Little information
is available
about refusal rates related to the use of different assessment
techniques.
Given Peters et al.'s (1986) finding of higher rates of abuse
disclosure
during interviews than on questionnaires, more investigation
of this issue
is warranted.
Observational
Coding Systems
A limited number
of observational coding systems have been developed for
the assessment
of maltreatment. These are limited to the assessment of
psychological
abuse, the form of maltreatment most likely to be accessible
to an observer.
For example, Crittenden (1988) developed a system that
attends to
maternal controllingness, unresponsivity, and hostile affect;
whereas Brassard,
Hart, and Hardy (1993) developed psychological maltreatment
scales for
analyzing parent-child interactions. Limitations of these methods
include that
they require extensive training of coders and may be difficult
to transfer
from research to clinical settings. In addition, they are based
only on a sample
of behavior, which may not generalize to the child's life
experience,
and they are unlikely to uncover forms of maltreatment other
than psychological
abuse. Therefore, although observations of parent-child
interactions
contribute to our understanding of the effects of violence
on children
(Graham-Bermann & Levendosky, 1998; Holden & Ritchie, 1991),
they are unlikely
to suffice as a measure of child maltreatment per se.
Comparison
of Approaches
to Assessing
Maltreatment
Various means
have been used to obtain ratings of child maltreatment-parent
and child self-reports,
interviews, and case record reviews. Each method
is vulnerable
to some criticisms and has both strengths and limitations.
Very little
work has been done to compare the accuracy or utility of these
different strategies.
Research that obtained multiple ratings from multiple
perspectives
would allow us to assess the costs and benefits of each approach.
In this regard,
two important studies directly compared methods of assessing
reports of
child maltreatment. Kaufman, Jones, Steiglitz, Vitulano, and
Mannarino (1994)
compared data obtained from child protection workers,
parents, reviews
of medical records, and clinical observations. Significantly
more, and more
severe, maltreatment experiences were uncovered through
parent reports
and medical record reviews than through protection workers'
reports, particularly
regarding psychological abuse. These authors also
developed a
4-point scheme for rating the severity of children's experiences
of physical
abuse, neglect, sexual abuse, and emotional maltreatment, which
allows for
summarizing data across reports.
Next, McGee
et al. (1995) compared data coded from agency case files, global
ratings provided
by case workers, and adolescents' self-reports obtained
via interview.
The best agreement was between case record data and the
ratings of
social workers (87%), but agreement between adolescent and other
reports was
still good (75%) . However, the authors found that there was
a tendency
among adolescents to fail to report all types of documented
maltreatment
experiences. This was particularly the case for neglect, which
may not be
perceived as abusive by children who have experienced no other
kind of parenting.
Significantly, however, despite adolescents' tendency
to underreport
abuse, their ratings better predicted adjustment problems
than did ratings
obtained from other sources. As the authors conclude,
although each
source of data may provide a unique "window" into children's
experiences,
which contributes to our understanding of them, children's
own subjective
appraisals of events are important moderators of their effects.
ETHICAL CONCERNS
What Are the
Consequences of
Uncovering
Maltreatment in
Children of
Battered Women?
The duty to
report. One of the primary ethical considerations in assessing
child abuse
in children of battered women concerns the limitations on confidentiality
resulting from
the interviewer's responsibility to report such information.
Reporting laws
vary considerably, however, and it is essential that investigators
be familiar
with the exact language of the statutes that govern the duty
to report in
their locality (Azar, 1992). In some jurisdictions, researchers
are exempt
from the duty to report (Sullivan et al., 1996), but this is
usually not
the case (Liss, 1994).
Another difference
among child abuse reporting laws is that in some jurisdictions
what must be
reported is present danger to the child. Thus, past incidents
do not require
a report when the child is currently being protected from
the perpetrator-as
in the case of children residing in a battered women's
shelter who
were abused by their fathers. In other jurisdictions, reporting
laws require
that all incidents of child maltreatment be communicated to
authorities,
no matter how long ago they occurred nor how unlikely it is
that the child
will encounter the perpetrator again. Furthermore, because
exposure to
violence toward the mother is defined as a form of child emotional
abuse in some
reporting laws, this would, strictly speaking, require a
report to the
authorities to be made about all children residing in shelters.
This is seldom
done in practice. However, it is the case that some researchers
will be involved
frequently with reporting information obtained during
interviews
with battered mothers.
There are many
concerns that arise from the mandate to report child abuse
in the case
of children of battered women. First, reporting involves breaking
confidentiality,
which can negatively affect the trust necessary to establish
rapport between
interviewer and research participant (Cicchetti & Manly,
1990). This
is of particular concern in working with battered women, who
are likely
to find the experience of a social services report to be highly
distressing.
In addition, women in shelters are fearful that their whereabouts
will be revealed
to their abusers. The experience of having a report made
to child protective
services can be experienced not only as a violation
of confidentiality
but as a life-threatening event.
Second, although
the relevant government body informed us that it would
consider children
residing in shelter to be protected from an abusive man,
economic and
psychological pressures frequently lead battered women to
return to their
abusers. Therefore, there may be cases in which interviewers
are still in
a dilemma about whether the duty to report pertains.
Third, although
the strongest links are between male violence to their
partners and
children Jouriles, Murphy, & O'Leary,1989; McCloskey et al.,1995;
O'Keefe,1994,1995),
battered women are under the kind of stress that increases
the risk that
they might maltreat their children as well. This may occur
through direct
physical violence (Straus et al., 1980) or emotional unavailability
secondary to
a battered mother's own depression and traumatization (Augustyn,
Parker, Groves,
& Zuckerman,1995; Osofsky, 1995). Therefore, it is possible
that not only
the batterer but the woman herself will need to be reported.
The repercussions
of such a report can be profound to the mother. Abusive
men often attempt
to exert control over their partners through threats
to harm or
take the children, and a woman may fear that a report to social
services will
be used against her by a vindictive partner to remove the
children from
her custody.
All of these
issues require careful consideration-by investigators, by
the battered
women's support community, and by the women and children who
are invited
to participate in research. Although allowing researchers an
exemption from
the duty to report may seem to provide a simple solution,
it does not
alleviate all concerns. For example, it has been argued that
whether legally
mandated or not, an ethical obligation remains to protect
children who
might be endangered (Hoagwood, 1994; Society for Research
in Child Development,
1996). As Azar (1992) states, although anxieties
about the negative
impact of reporting may be justified, the impact of
failure to
report-that the child might be harmed-should take precedence.
Obtaining inforned
consent Because negative consequences may ensue from
disclosures
during research interviews, care must be taken during the informed
consent procedure
to ensure that women-and children-understand fully the
limits to confidentiality
arising from their participation in research
(Fisher, 1994).
Interviewers should take care to review the conditions
under which
a report must be made in simple, child-oriented language to
both parents
and children prior to asking them whether they would like
to participate
(e.g., "The one thing I can't keep private is if a child
might be hurt;
then I have to tell someone so that we can make sure she
or he is safe")
(see Peled & Davis, 1995). In addition, both mothers and
children should
be reminded of the limits to confidentiality before beginning
any questionnaires
that explicitly ask about children's abuse experiences.
Fully informed
consent will ensure that participants do not feel surprised
or betrayed
by an interviewer's breaking of confidentiality.
Ethical Procedures
With
Children of
Battered Women
A separate
ethical concern revolves around the ability of children to make
informed choices
about participation in research. Because of their minor
status, children
do not have the legal right to give or withhold consent.
However, every
effort must be made to obtain children's assent (American
Psychological
Association, 1992; Koocher & Keith-Speigel, 1990; Society
for Research
in Child Development, 1996). Ferguson (1978) has argued that
even young
children can be helped to participate in the informed consent
process, when
due attention is paid to their cognitive abilities and need
for adult support
for their assertions of autonomy.
Moreover, a
study of children's comprehension of the informed consent procedure
found that,
whereas children generally understood that they could choose
to stop participating,
younger children were not sure how to actually accomplish
that (Abramovitch,
Freedman, Thoden, & Nikolich, 1991). In addition, many
children believed
that there would be negative consequences for refusing
to comply with
the researchers and felt particular pressure to acquiesce
when permission
had already been given by their parents. Therefore, special
care must be
taken in obtaining assent from children, especially young
children.
To support
children's freedom to give or withhold assent, interviewers
can ask each
mother to first give her verbal assurance to children that
she will allow
them to make their own decision about whether or not they
would like
to participate. The introduction to the study should also make
clear that
mothers and children may freely decline to answer any question
put to them,
or to complete any questionnaire, with no negative consequences.
For example,
young children may need to be told explicitly that the interviewer
will not be
"mad" or "unhappy" and that any honorarium offered will
still
be available
to them, whether or not they answer every question. However,
children may
find it difficult to not comply with the interviewer's expectation
that they will
answer questions put to them. Therefore, it is important
to attend to
nonverbal cues that might indicate a child's unwillingness
to continue
with an interview, such as avoidance of eye contact, fidgeting,
or rigid posture.
A second consideration
has to do with whether children are cognitively
sophisticated
enough to understand the information presented to them and
thus fully
comprehend such important issues as the limits to confidentiality,
should they
reveal information about child abuse. For example, Kalter,
Schaefer, Lesowitz,
Alpern, and Pickar (1988) report that young children
often misunderstand
confidentiality as meaning that they must keep secret
from parents
what they say to the interviewer. Furthermore, Ogloff and
Otto (1991)
found that consent forms used in research were written at a
higher educational
level than one would find in an average community sample.
We are not
aware of any similar studies having analyzed the complexity
of the language
used to obtain children's assent, but with the availability
of tools for
assessing reading level in most word processing programs,
this could
be done easily by individual researchers.
Third, there
is often concern expressed about potential harm to participants-particularly
children-of
being asked directly about sensitive topics such as family
violence. Indeed,
some have questioned the ethics of conducting any research
with children
of battered women. Straus (1981), however, refers to this
as the "fragility
of subjects" fallacy and argues that there is no direct
evidence that
being asked to reveal such information is harmful to voluntary
research participants.
Lack of evidence is clearly not evidence to the
contrary, but
what is unstated, perhaps because it is assumed to be understood,
is the necessity
for researchers to treat child participants with due care
to assure that
such questions do not distress or offend them. It may be
helpful to
keep in mind that both research and clinical work have documented
that talking
with a supportive adult about even the most traumatizing of
experiences-including
abuse, homicide, and rape-causes relief rather than
distress for
children (Arroyo & Eth, 1995; Pynoos & Nader, 1988) . This
is particularly
the case in situations such as family violence, in which
the burden
of secrecy is an additional source of stress for children (Silvern,
Karyl, &
Landis, 1995).
Interviewer
Training
Even when interviewers
do not ask participants directly about child maltreatment,
there is always
the potential that disclosures will occur inadvertently
(Jaffe et al.,
1990). Training is essential to prepare interviewers to
hear of a child
being hurt without reacting with anxiety, outrage, or horror.
The most helpful
response to disclosures is an empathic "under-reaction"
(MacFarlane
& Waterman, 1986), which communicates concern without criticism
or shame. The
skills necessary for effective and ethical interviewing of
children of
battered women include knowledge of child abuse reporting laws
and the procedure
for acting on them, good interpersonal skills and the
capacity to
cope well with upsetting emotions, and strong clinical judgment
and acumen.
Therefore, there is a strong case to be made that such interviews
should be conducted
by individuals with advanced training in counseling
and clinical
or social work.
Reframing the
Reporting of
Abuse: From
Hindering to Helping
Even when warned
as to the interviewer's duty to report maltreatment, and
despite fears
about the consequences, many women and children do reveal
such information
during research interviews. One reason for this is that
a sensitive
and empathic interviewer creates a supportive relationship
that encourages
trust and openness. Furthermore, women whose partners have
harmed their
children, or who themselves have succumbed to negative impulses
and aggressed
against their children, often wish to stop this behavior.
Therefore,
the perspective of the battered woman herself needs to considered.
Concern about
the wellbeing of her children often has a determining role
in a battered
woman's decision whether or not to leave her violent partner-either
that the children
are endangered, and therefore she must leave, or that
her leaving
could negatively affect them, and so she must stay (Hilton,
1992; Tomkins
et al., 1994). Would it make sense to a woman if mental health
professionals
did not intervene when they learned her child was at risk?
And how would
a child interpret an adult's learning of abuse but doing
nothing to
help? In this regard, an intriguing study found that adolescents
believed researchers
should break confidentiality when youths reveal risky
behavior or
victimization, because otherwise, it would seem that the adults
conducting
the research did not care (Fisher et al., 1996). Reporting done
with care,
and for the purposes of demonstrating care, may be not only
acceptable
but even welcome (Egeland, 1991).
Therefore,
rather than framing the reporting of abuse as a betrayal of
the trust established
between interviewer and interviewee, it is perhaps
better characterized
as an extension of that trust. Women who reveal that
their children
have been mistreated are seeking help, and involvement of
the child protective
agency can be presented to them as an opportunity
to obtain the
support and services that are available in their community
(Committee
on Professional Practice and Standards, 1995).
An overarching
goal when working with battered women is to allow them to
re-establish
the sense of control over their lives of which the abuser
deprived them.
Reporting a woman to the authorities may appear to be the
epitome of
disempowerment-or even revictimization (Jaffe et al., 1992)-and
yet it need
not be. Women can be actively involved in the reporting process;
with the interviewer's
help, they can contact child protective services
themselves
and take ownership and control over ending violence in their
lives. In addition,
interviewers can support women through the procedure
and educate
them so that they are fully informed as to what will take place.
The active
voluntary participation of the mother in the process will also
increase the
likelihood that she will be able to engage in a positive and
collaborative
relationship with the agent who is called to investigate
the report
(Egeland, 1991).
Enhancing the
working alliance between investigators and shelter workers.
Parallel to
the concerns of battered women, the possibility that involvement
in research
will result in a woman being reported to child protective services
can be a stumbling
block to the formation of a cooperative alliance between
investigators
and the battered women's support community. Although the
needs of both
women and children are generally both taken into consideration,
this is one
issue which the interests of children and their mothers could
be seen to
be in conflict (Cummings & Mooney, 1988; Jaffe et al., 1990).
Here again,
a reframing is in order, such that those who report concerns
about child
maltreatment are perceived as helpers rather than punishers.
In this regard,
Hughes (1982) made a number of concrete suggestions regarding
the positive
roles that child protection services can play in battered
women's shelters,
for example, by offering parenting courses and children's
support groups.
Similarly, Cummings and Mooney (1988) suggest that greater
cooperation
between shelter staff and child protection workers could be
fostered by
their hosting joint training seminars, professional development
programs, and
case conferences. Similar recommendations could benefit the
collaboration
between researchers and shelter staff.
[IMAGE TABLE]
Captioned as: TABLE 1: Summary of Issues and Recommendations
CONCLUSION
In summary,
this review has identified a number of directions for future
developments
in the assessment of child maltreatment in children of battered
women, as well
as ways to improve practice in the field (summarized in
Table 1). Although
much further work is needed, the effort will be worthwhile.
It is only
by carefully evaluating the extent of both exposure to violence
and maltreatment
of children that we can understand, differentiate, and
prevent their
effects.
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Patricia K.
Kerig
James Madison
University
Anne E. Fedorowicz
Simon Fraser
University
Authors' Note:
The authors would like to thank the members of the research
team who assisted
with this work, particularly Corina Brown, Michelle Warren,
and Karen Rowa.
Correspondence concerning this article should be addressed
to Patricia
K Kerig, School of Psychology,James Madison University, Harrisonburg,
VA 22807. E-mail
may be sent to kerigpk(R)jmu.edu.
CHILD MALTREATMENT,
Vol. 4, No. 2, May 1999 103115
(c)1999 Sage
Publications, Inc.
Patricia K
Keig is an associate professor of clinical psychology at James
Madison University
and a staff psychologist at the Shenandoah Valley Child
Devent Clinic.
Her research is in the area of developmental psychopathology,
with specific
interests in the study of family processes, gender differences,
and the search
for protective factors for children exposed to interparental
conflict and
violence.
Anne E. Fedorowicz
is a doctoral student in clinical psychology at Simon
Fraser University.
Her research interests include the assessment of children's
coping and
the study of resiliency in maltreated children.
Reproduced
with permission of the copyright owner.
Further reproduction
or distribution is prohibited without permission.
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