Article by Barry Goldstein
One of the most important research studies about the impact of domestic violence on children began as a project to treat morbidly obese patients and help them lose substantial amounts of weight by eating no food but taking supplements to satisfy their nutritional needs. Some patients failed to lose the expected weight because they did not follow the protocol, but it was successful patients who were the ones to drop out of the program. Upon studying the personal records and interviewing the patients who left, Dr. Vincent Felitti came to understand that rather than a problem, the patients had viewed their excessive weight as a protective factor. They had experienced childhood trauma, particularly sexual abuse and believed their weight would discourage anyone from attacking them.
These findings led Dr. Felitti with the assistance of Dr. Robert Anda of the Center for Disease Control (CDC) to create of study involving over 17,000 middle-age patients in order to understand how childhood trauma impacted their health. This became the original ACE (Adverse Childhood Experiences) research. The first study was released in 1998 and since that time the CDC has sponsored at least five additional studies in other cities that confirmed and expanded on the findings of Dr. Felitti. There have now been over 80 research papers written for medical professionals about ACE research.
The patients were asked about ten different types of trauma in their childhood. The traumas were selected based on their prevalence in the obesity program. The traumas considered were domestic violence; physical, emotional, or sexual abuse; an adult in the household who engaged in substance abuse; was imprisoned; depressed or mentally ill; separation from at least one of the biological parents; emotional neglect; and physical neglect. An ACE Score was created wherein the patient received one point for exposure to each type of trauma. The point was given whether there was one incident or many so the calculation often understated the harm.
The fundamental finding in the ACE research is that children exposed to domestic violence, child abuse and other trauma will suffer more illnesses and injuries throughout their lives and have a shorter life expectancy. The harm is cumulative so that each additional form of trauma multiplies the risk. Other research demonstrates that fathers who commit domestic violence are more likely to also commit child abuse. Thus if a child was exposed to domestic violence, verbal, physical and sexual abuse, that would create an ACE score of 4. If one of the parents also had a substance abuse problem or these events led to the removal of one of the parents from the child’s life the ACE score would be 6. At this level a child has a life expectancy twenty years less than a child with none of these traumas.
On first consideration these findings are depressing, but they also offer an incredible opportunity. If society can protect children from domestic violence and child abuse, we would enjoy a dramatic improvement in the health of children and adults with huge financial savings. The initial reports and articles have been directed at the medical community. This is useful because doctors can use this information to diagnose and treat adult patients suffering from a variety of illnesses that were caused by trauma experienced decades earlier. I am now working with Dr. Felitti to use this research for purposes of prevention.
In 1964 the Surgeon General’s report linking smoking and cancer was released. The tobacco industry initially attacked the report and denied the findings. Today the American Cancer Society and the American Heart Association would not consider doing their work without a component to discourage smoking. This has led to a significant reduction in smoking and therefore less cancer, heart disease and deaths.
The ACE research has linked the childhood traumas studied to the ten leading causes of death in the United States. We believe that charitable organizations working to prevent many common diseases and societal problems should include a component to prevent domestic violence and child abuse in their work. This would include organizations working to prevent cancer, heart disease, diabetes, asthma, auto-immune diseases, Aids, substance abuse, depression, suicide, eating disorders, PTSD, rape and many other scourges of society.
Understanding the pathways from abuse to illness will help professionals develop appropriate responses to domestic violence and child abuse. Domestic violence involve tactics abusers use to coerce and control their partners. The purpose of the tactics is to frighten and intimidate the victim so she does what the abuser demands even if she does not agree. Even more than the immediate harm from any physical abuse, it is this stress and fear that impacts victims and their children to produce the long-term medical risks. Many common diseases are caused or exacerbated by stress. The stress also causes inflammation which is associated with many health risks. The abuse and stress also lead to eating and sleeping disorders which in turn cause still more medical problems. Domestic violence and child abuse are also linked to depression and PTSD. The laws that require courts to consider domestic violence when making decisions about custody and visitation were based on research that children exposed to domestic violence were more likely to make a variety of poor choices. This leads to problems like substance abuse, crime, prostitution, teen pregnancy, dropping out of school, self-mutilation, suicide and depression. Significantly, these health problems and poor decisions interact with each other to increase risks exponentially.
How domestic violence and child abuse harm children is critical to understanding the most effective responses. Some professionals look to individual incidents and tend to focus on physical abuse. In a situation where a man and woman hit each other the professional might make the mistake of assuming the behaviors are equivalent. Aside from whether one assault was more severe, an important question is who is afraid of their partner. In many cases the woman is smaller and physically weaker and so the man is not afraid the way the woman is. Furthermore the physical incident is part of a pattern of coercive and controlling behavior that creates the stress and fear associated with health risks. This is why context is so important to understanding domestic violence. Approaches that look only at physical abuse, minimize the significance of domestic violence, miss the underlying pattern and the impact on the victim or focus on less important issues will fail to protect children from the catastrophic risks described in the ACE research.
The Saunders’ Study: Recognizing True Abuse Complaints
The disastrous impact on children of exposure to domestic violence and child abuse should require that psychologists and judges err on the side of safety and make sure they can recognize true allegations of abuse. The study by Dr. Daniel Saunders of the University of Michigan was released by the U. S. Department of Justice in April of 2012. Dr. Saunders recommended that evaluators and other professionals receive training about the impact of domestic violence on children. The ACE research confirms the importance of this information.
The purpose of the Saunders’ study was to consider the training of evaluators and other court professionals regarding domestic violence. He recommended that they have training in screening for domestic violence, risk assessment, post-separation violence and the impact of domestic violence on children. Many of the findings from this research raise concerns that court professionals do not have the training they need and this frequently leads to the failure to protect children.
Dr. Saunders emphasized that the selection of evaluators and other professionals to participate was not done on a random basis. He relied on volunteers and it is reasonable to believe the sample was weighted towards the best professionals who agreed to participate because they had greater training and interest in domestic violence issues than their colleagues. Despite this, however, approximately 30% of the evaluators said they did not have all of the necessary training. Even this understates the problem as other questions demonstrated the lack adequate training is far more widespread. Although most evaluators claimed they screened for domestic violence, when asked what tools they used most relied on standard psychological tests. These provide no information about domestic violence which means the evaluators were not conducting any effective screening. Their answers to vignettes further demonstrated inadequate understanding of domestic violence. This is the worst possible situation because these professionals did not have the necessary training but believe they do so they would be unlikely to consult with genuine experts.
Dr. Saunders found that evaluators and other professionals without the needed training tended to focus on the myth that women frequently make false allegations, unscientific alienation theories and the assumption that mothers seeking to protect children from frightening fathers were actually harming the children. Many domestic violence custody cases focus on these issues which means the courts are frequently relying on unqualified professionals. The Saunders’ study found that professionals using these methods create outcomes that hurt children.
The study also looked at what Dr. Saunders referred to as “harmful outcome” cases. These are extreme outcomes in which the alleged abuser wins custody and the safe, protective mother who is the primary attachment figure is limited to supervised or no visitation. These are typically cases in which the mother raised concerns about abuse, but the court disbelieved her. Saunders found these outcomes are always wrong because the harm of separating the children from their primary attachment figure, damage that includes increased risk of depression, low self-esteem and suicide when older is greater than any benefit the court thought it was creating. In most of these cases the extreme outcome was caused by a very flawed process so frequently the opposite outcome would have benefited the children. The frequency of these harmful outcomes confirms the courts routinely rely on unqualified professionals.
Quincy Model 2.0:
Would Anyone Like to Share $500 Billion Every Year?
The ACE research demonstrates the enormous harm caused by tolerating domestic violence and child abuse. It not only reduces the quality and length of millions of lives, but creates enormous economic harm that impacts all of society. Research about the original Quincy Model proves that domestic violence and child abuse are not inevitable and that they can be dramatically reduced by using a group of best practices that are easily implemented. The Saunders’ study provides information on how to reform the custody court system which must be included in order to enjoy the enormous benefits from the Quincy Model with its reduction in domestic violence crimes and child abuse.
A group of leaders in Quincy, Massachusetts first individually and later working together developed a series of best practices to prevent domestic violence crime that became known as the Quincy Model. The people in Norfolk County benefited from this program from the late 1970s until the mid-1990s. District Attorney, Bill Delahunt reviewed the personal records of inmates at a nearby high security prison and noticed that virtually everyone had a childhood history that included domestic violence and/or sexual abuse. He realized that if they could prevent domestic violence crime, all crime would be reduced and that is exactly what happened. A county that had averaged 5 or 6 domestic violence homicides every year had none for several years, then one and back to none.
Some other communities like Nashville, San Diego and Duluth had similar good results with similar best practices. When some of the best practices were abandoned the murder and crime rates went back up. Since Quincy new research and technologies have become available and can be used to strengthen the model. During the Quincy Model some complaining witnesses stopped cooperating after their abusers sought custody in the Probate Court. This undermined but did not derail the Quincy Model because this abuser tactic was less common. Today it is standard practice for the worst abusive fathers to seek custody as a way to regain control over their victims. Most custody cases are settled more or less amicably. Even in cases with abusive fathers the litigation is settled because the fathers love their children and are unwilling to deliberately hurt them by separating the children from their mothers. This often results in a settlement in which the mother gives up resources and financial support in return for custody. The biggest problem in custody courts are the 3.8% of cases which cannot be settled and go to trial and often far beyond. These are overwhelmingly domestic violence cases that cannot be settled because the abuser is willing to hurt the child in order to control and punish the mother. At the same time the abusers are very manipulative and as the Saunders’ study demonstrated the court professionals do not have the training to recognize domestic violence. The problem is compounded by the development of a cottage industry of lawyers and evaluators that earn large incomes by supporting practices that help abusers. Domestic violence is about control and includes control of the family financial resources. Accordingly the best way for professionals to make a good living is to support the side with the money.
Many court professionals are taught to misunderstand these disputes as “high conflict” cases. That assumes the victim and the abuser are equally responsible for the conflict. The courts often pressure victims to cooperate with their abusers instead of forcing the father to stop his abuse if he wants a relationship with the children. The Saunders’ study found that courts frequently place too much emphasis on the emotions and anger of the mother out of proportion of what it says about her parenting. Many court-sponsored committees have found widespread gender bias against women. One common example is blaming mothers for their normal reactions to the fathers’ abuse. Dr. Saunders found that courts are not requiring supervised visitation for alleged abusers as often as they should. Every year in the United States, 58,000 children are sent for custody or visitation with dangerous abusers.
Bill Delahunt created a section in his office to prosecute incest and child sexual abuse crimes. He believed that most allegations are true despite assumptions at the time that children frequently made false complaints. The original ACE study included a confidential questionnaire of over 17,000 middle age patients. 22% stated they were sexually abused as children. They had no reason to lie about this and in fact some patients probably denied abuse because of embarrassment or defense mechanisms caused them to forget. Accordingly we know sexual abuse of children is far more common than we would like to believe. Nevertheless, although research confirms mothers make deliberately false allegations of sexual abuse less than 2% of the time, custody courts are giving the alleged sexual predators custody in 85% of these cases. This means courts are sending a lot of children to live with their rapists. In this context Saunders’ finding that inadequately trained professionals tend to focus on the myth that women frequently make false allegations is especially important.
The same pathways described in the ACE research that cause health problems to children from domestic violence and child abuse also impact direct victims of domestic violence. The Academy on Violence and Abuse studied the medical costs and estimated the United States spends $333-750 billion per year on health costs related to domestic violence. I believe the higher amount is more likely because even in medical settings victims often deny or minimize their partner’s abuse. We spend over one trillion dollars per year on crime costs and at least $200 billion is caused by domestic violence. Many victims, children, third parties and abusers never reach their financial potential substantially undermining the economy. This means in the United States, domestic violence costs us over one trillion dollars annually and should be thought of as a subsidy for abusers. Even the best practices won’t end all domestic violence or related child abuse, but based on past successes, Quincy Model 2.0 can prevent 80% of domestic violence crime and save at least $500 billion annually.
Quincy Model 2.0 is not magic, but just the use of a group of best practices we know can prevent domestic violence. This includes strict enforcement of criminal laws, orders of protection and probation conditions; practices that make it easier for victims to leave; coordinated community response; multi-disciplinary approaches, use of current scientific research and technology like GPS; and reform of the custody courts so abusers can no longer manipulate the courts to gain custody or pressure their victim to return.
Most women will no longer have to cope with domestic violence. Children will live in safer homes and grow up happier and healthier. We will all benefit from a stronger economy, less crime and dramatically reduced health insurance costs. Of course in order to gain these life changing benefits, abusive men will no longer be able to terrorize and control their families. Sounds like the best deal we could ever make.
Barry Goldstein is a nationally recognized domestic violence author, speaker and expert. Barry is the co-editor with Dr. Mo Therese Hannah of DOMESTIC VIOLENCE, ABUSE AND CHILD CUSTODY and co-author with Elizabeth Liu of REPRESENTING THE DOMESTIC VIOLENCE SURVIVOR. He is currently working on a book for the general public that is likely to change how society responds to domestic violence. NOT A PRIVATE MATTER: ENDING THE $500 BILLION ABUSER SUBSIDY provides a realistic plan to drastically reduce domestic violence crimes and 500 billion reasons to do so. To learn more about Barry's work, check out the rest of his site here and www.Domesticviolenceabuseandchildcustody.com Barry can be reached at Contact Barry