Ole Hultmann, Department of Psychology , University of Gothenburg ( ole.hultmann@psy.gu.se )

1. Children exposed to intimate partner violence and/or abused - findings from Swedish research projects in child psychiatry and child protection work Ole Hultmann, Department of Psychology, University of Gothenburg (ole.hultmann@psy.gu.se) Non ViolentChildhoods Stockholm, 8th of May, 2017

2. Child mental healthcare (CAM) – studies in Gothenburg 2009 – aims… • Enhancingskills in identifying patients in child mental healthcare (CAM) affected by intimate partner violence (IPV) and child abuse • Developing structuredinterviews to assessamount, type and chronicity of violence=> iRiSk-project…. • Deepeningunderstanding of the impact of violence on patients’ psychological symptoms • Testing TF-CBT in a randomised controlledstudy. https://gupea.ub.gu.se/handle/2077/40838

3. Aims and data collection 2011-14 • PrimaryAim: to compare CAM patients who had • both witnessed IPV and been subjected to child abuse (b) been subjected to either child abuse or witnessed IPV, but not both. Three items captured child abuse: “being beaten at home, being tied up or locked up at home, being subjected to sexual abuse at home”. One item captured IPV: “seen your parents hit each other or destroying furniture”

4. Participants: 578 consecutively enrolled patients agednine to 17 years old wereaskedaboutexperiencesofviolence Measures - violence: Ocurrenceofchild abuse and IPV Frequency age offirstexperience impact Violence outside the family Outcome measures: Self-reported symptoms, diagnoses, impact of violence exposure Method

6. Main results – impact on psychological symptoms • 14% of the patients reported abuse only, 14% exposure to IPV only, and 22% both (double exposure) • No differences in psychiatric symptoms or diagnoses were found between those exposed to IPV only or abused only, compared to those neither abused nor exposed to IPV • Double-exposed were more often assigned a PTSD diagnosis, had more self-reported psychological problems and regarded the impact of events as more severe compared to patients who were abused only or exposed to IPV only

7. Development and validation of a risk assessment interview for children exposed to intimate partner violence and child abuse.-projectreported 2013-2014http://psy.gu.se/digitalAssets/1532/1532050_irisk-rapport-2015x.pdf-ongoingprojectTestingthe usefulness and feasabilityofstructured risk assessmentsin childprotectionworkiRiSk – Utveckling av bedömningsinstrument och stödinsatser för våldsutsatta barn. Anders Broberg, Ulf Axberg, Åsa Cater, Maria Eriksson, Ole Hultmann& Clara Iversen .

8. Levels in the process of collection of information in childprotection work • Routinequestionsabout IPV and CA (parentalreports) • In depthquestionsif a parentscreens positive on routinequestions (parentalreports) • Full risk assessment with children and the non-abusiveparent (and the abusiveparent – to be developed)

9. Levels in the process of collection of information in childprotection work • Routinequestionsabout IPV and CA (parentalreports) • In depthquestionsif a parentscreens positive on routinequestions (parentalreports) • Full risk assessementwithchildren and non-abusiveparent (and abusiveparent – to be developed)

10. Step 1. Screening questions on IPV and child abuse in CAM and social service: Have you been hit, kicked, punched, or otherwise hurt by someone? When? By whom? (IPV) Have your child been kicked, punched, or otherwise hurt by the same person? (child abuse) Responders; N = 776, mostlywomen Main results: Approximately 3 of 10 parentsreported IPV Thoseaffected by IPV reportedchild abuse in 6 of 10 cases http://psy.gu.se/digitalAssets/1532/1532050_irisk-rapport-2015x.pdf

11. Levels in the process of collection of information in childprotection work • Routinequestionsabout IPV and CA (parentalreports) • In depthquestionsif a parentscreens positive on routinequestions (parentalreports) • Full risk assessmentwithchildren and non-abusiveparent (and abusiveparent – to be developed)

12. Step 2. In depthquestions… …parents, whomscreened positive on partner violence screen instrument, wereaskedabouttype(physical, psychological, sexual), degreeand frequency of IPV and childabuse screening positive on PVS indicated extensive and serious exposure to IPV and showedthat the childrenwereaffecteddirectly by violence as well. A majority of the childrenlived in a singleparentfamily (with the mother) and had visitation with the allegedperpetrator of violence.

13. Violenceagainstmothers (VMV) • Physicalviolence – 8/10 • Psychologicalviolence– 9/10 • Sexual violenceviolence– 3/10 • A majorityreportedviolenceduring the last year. • Conclusion: If parentsscreened positive on the routinequestions, therewas a goodchancethat the violencewas extensive.

14. Violence againstchildren (VMV) • Physicalviolence – 4/10 • Psychologicalviolence– 4/10 • Sexual violenceviolence– > 1/10 • The answersaboutviolenceagainst the childshowed high levels of violence

15. Levels in the process of collection of information in childprotection work • Routinequestionsabout IPV and CA (parentalreports) • In depthquestionsif a parentscreens positive on routinequestions (parentalreports) • Full risk assessmentwithchildren and non-abusiveparent (and abusiveparent – to be developed)

16. Assessing risk for recurrent IPV and CA The common strategy in childprotection is an openinterviewwith non-leading questions(Cederborg) Research shows that a combination of intuitive reasoning and analyticappraoach is the best wayto make decisions Manylayers in the information have to be regarded; parental capacity, amount and character of the violence, druguse, childrensdevelopmentalneeds, etc. Weknowverylittleabout the process of information gathering – howtoelicit relevant information aboutviolencethroughstructuredinterviews

17. Aimsof the currentiRiSkstudy Testing the usefulness and feasability of structured risk assessments in childprotection work from the perspectives of the social workers, parents and children. Further, the aim is to test the abilityof the instrument to predictrecurrentviolence.

18. Risk assessments Parental form 60 – 90 minutes, depending on the character and extension ofviolenceagainstparent and child Children 9 – 17 years40 – 60 minutes Children 5 – 8 years30 minutes

19. References • Broberg, A., Almqvist, K., Appell, P., Axberg, U., Cater, Å., Draxler, H., . . . Röbäck, K. S. (2015). Utvecklingavbedömningsinstrumentochstödinsatserförvåldsutsatta barn. [Development of instruments for assessment and support for children exposed to violence]. • Broberg, A., Hultmann, O., & Axberg, U. (2016). Förekomst, bedömningochbehandlinginom barn- ochungdomspsykiatrin (BUP) avpatientersomutsattsförvåldifamiljen. Bilaga till slutrapport till FORTE avseende FAS-projekt nr. 2011-0350. Göteborg: Psykologiskainstitutionen. • Hultmann, O. (2015). Child Psychiatric Patients Affected by Intimate Partner Violence and Child Abuse – Disclosure, Prevalence and Consequences. (PhD), University of Gothenburg, Gothenburg. • Hultmann, O., & Broberg, A. (2015). Family violence and other potentially traumatic onterpersonal events Among 9- to 17-year-old children attending an outpatient psychiatric clinic. Journal of Interpersonal Violence. doi:10.1177/0886260515584335 • Hultmann, O., Broberg, A., & Axberg, U. (2016). A randomized effectiveness study comparing trauma-focused cognitive behavioral therapy with therapy as usual in a child psychiatric clinic. Manuscript in preparation. • Hultmann, O., Broberg, A., & Axberg, U. (2017). Child Psychiatric Patients Exposed to Intimate Partner Violence and/or Abuse - the Importance of Double Exposure. Submitted manuscript.