**11. Conclusion**

50 Child Abuse and Neglect – A Multidimensional Approach

with other professionals and learning from them [139].

child-focused care.

[128, 130].

**9. Midwifery settings – Differences in community and hospital-based** 

Findings from research show that significantly fewer midwives in hospital settings are addressing the issue of domestic abuse with their clients, as they appear to be driven by more medically dominant organizational structures and targets, which result in them using a more standardized form of care that stresses measures of efficiency, effectiveness and risk management [125]. According to this study hospital midwives work in a setting that has an ideology which places less emphasis on the psychosocial needs of the individual woman and her child and more on providing care for women experiencing complications, and thus public health issues are seen as low priorities. These findings are consistent with work by Hunter [136] whose results suggest that the occupational ideology of the hospital midwife is 'with the institution' rather than with a more 'woman-centred' approach. On the other hand, more midwives from community-based settings appear to follow more women-centred and

Firstly, community midwives are able to create a healthy living environment for women experiencing domestic violence, by asking about 'abuse' with their clients [137]. Secondly, they integrate health promotion and health empowerment into the primary care setting by working in partnership with the woman in their own homes, frequently talking to them about issues such as domestic and child abuse, and are more aware of providing private facilities in which woman can discuss violent relationships. Thirdly, they develop links with other settings and with the wider community [138]. Community, midwives are more empowered to use a joined-up approach that includes an understanding of evidence-based research in the area, a clear knowledge of local and national multi-professional support agencies, and inter-agency networks and refuges that allows them to give on-going and appropriate information that in itself can empower women to make their own informed choices about how to deal with abuse [125]. The Code of Professional Conduct exhorts midwives to work collaboratively, to enable them to strengthen areas of practice by liaising

However, the biggest hindrance recorded for both hospital and community midwives is the reluctance of a partner to leave the consultation. Recent changes in midwifery practice designed to 'empower women' and demedicalize childbirth may in reality be reducing the possibility of effective intervention i.e. the traditional concept of women-only space is rapidly disappearing as more and more men are now accompanying their partners to their antenatal and postnatal visits. Women now hold their own notes, eliminating confidential documentation of suspicions of/or identified cases of domestic violence. This can lead women themselves to feel emotionally unable to, or physically prevented from, accessing support, either from their family and friends, or from statutory and voluntary agencies. International research evidence illustrates that maternity services are no longer woman-only spaces because women are now accompanied by their partners when attending antenatal clinics, and partners are often present in primary care appointments Globally health services including maternity services play an important role in safeguarding children. Within the UK health care professionals ensure that children and families receive the care, support and treatment they need in order to promote children's health and development. Staff such as midwives, health visitors, obstetricians, general practitioners (GPs), and other staff who work as members of the primary care, or hospital maternity team have a safeguarding role to play in the identification of babies and children who have been abused, those who are at risk of abuse, and in subsequent intervention and protection services. In the UK we expect that every pregnant woman will have access to, and engage with, high quality maternity services. It is also increasingly acknowledged that for the majority of women, pregnancy and childbirth are normal life events and that care of these women and their babies may be undertaken exclusively through midwifery-led services. The universal nature of health provision means that maternity professionals such as midwives and obstetricians are often the first to be aware that families are experiencing difficulties. All health care organisations have a duty under the Children Act 2004 to make arrangements to safeguard and promote the welfare of children and young people. Every Child Matters marked a shift of focus from child protection to improving and promoting the health and wellbeing of all children and incorporates several important themes.

However the evidence suggests that domestic abuse is a damaging social problem affecting the health of many women and children within pregnancy and the first postpartum year. It cannot be solved by one profession alone; however, the professional's role in identification and referral plays a critical part in primary care co-ordinated response. In order for such a response to be effective, all professionals need greater exposure to and familiarity with recommended good practice; and must be able to identify and support women and children who are experiencing abuse with a joined-up approach that has adequate resources and support of health service managers. Close inter-agency liaison is required with professionals who are accountable and not afraid to challenge historical working practices, and who are willing to work across traditional boundaries.

Recognizing the Co-Occurrence of Child and Domestic Abuse in Pregnancy and the First Postnatal Year 53

ensure appropriate decisions are made about when to intervene. The availability of appropriate treatments to meet the needs of these infants, however, still remains a challenge [140]. Developing effective interventions and services is vital in order to support parents in meeting their children's health and wellbeing needs. A radical rethink of early intervention services is underway, blueprints for integrated working are being developed, bringing with them the opportunity to deliver meaningful and long term changes to the lives of young children across the country. Primary prevention efforts could thus be marketed universally, to further reduce the stigma associated with 'parent training': every parent can benefit from

Concerns over inadequate record keeping, poor information sharing, and communication have also been raised by the Commission for Health Improvement [141] between NHS organizations and other agencies with respect to violence and abuse [142]. Developing a system that allows the sharing of information and statistics on abuse would immensely benefit professionals and the families with which they work, as it could provide interpretation of the multiple contributing factors associated with domestic and child abuse. This information would provide baselines to establish education, prevention and treatment programmes [112], to formulate benchmarks for performance evaluation, as well as allow professionals to collaborate and provide assistance and protection to victimized children in

*"Improvements to the way information is exchanged within and between agencies are imperative if children are to be adequately safeguarded. Effective action designed to safeguard the well being of children and families depends upon the sharing of information on a multi-professional, inter-agency* 

Finally the co-occurrence of risk factors for violence in pregnancy, where the health and safety of two potential victims are placed in jeopardy [53, 54, 55] stresses the importance for all health professionals and the primary care team to be able to recognize and report domestic and/or child abuse at this time Identifying domestic abuse, however, may be a useful risk factor for recognizing child abuse, which is clearly within the appropriate domain of professionals working in maternity or primary care services. Although tensions between the 'best interests of the mother' and the 'best interests of the child' are not always easily responded to, Fleck-Henderso n [144] suggests that best practices for families, where both children and women are at risk of violence, requires professionals to 'see double;' drawing from the knowledge and values of both perspectives to best meet the needs of these families. 'Seeing double' should therefore apply to all professionals in every child abuse case

*NSPCC Reader in Childhood Studies, School of Sociology, Social Policy and Social Work,* 

a more efficient and effective way. As Lord Laming states in his report:

parent skills training, not just the 'bad' ones.

*basis [143]."* 

involving domestic violence.

*Queen's University of Belfast, Northern Ireland, UK* 

**Author details** 

Anne Lazenbatt

Importantly evidence shows it is possible to prevent abuse and neglect and that the pregnancy and infancy offer a unique window of opportunity to work effectively with families at risk. Although we know that sustained maltreatment can have major long-term effects on all aspects of children's health and mental wellbeing, and impair their functioning as adults [81], many health professionals still remain unaware of these longterm health and wellbeing impacts on infants and younger children [119]. We know that the earliest years of life are a critical period when infants are making socio-emotional attachments and forming the crucial first relationships which lay the foundations for future health and wellbeing [84]. All types of maltreatment can affect an infant's emotional, psychological and mental wellbeing, and these consequences may appear immediately or years later. Enhancing the prospects for healthy development in the lives of maltreated infants therefore requires attention to enhancing opportunities for positive, non-violent family and peer interactions. The evidence tells us that pregnancy and the first year of life is a window of opportunity for preventive interventions and a crucial time to reduce later emotional, psychological and developmental difficulties, and develop stronger infant-parent relationships. The importance of preventing child maltreatment and thereby its short and long-term developmental, health and mental health consequences cannot be underestimated. Whilst efficiency savings are clearly key drivers behind much of the recent 'Early Years' policy developments in the UK, it is also clear that there are great opportunities to rethink and redesign how we support parents of very young children. How midwifery, obstetrics, paediatrics, social care, education and criminal justice professionals develop mechanisms for sharing resources and working together creatively to meet the needs of families will be central to the success of this preventative agenda.

Given new evidence that trauma in pregnancy and infancy alters the physiology of the brain, it is time for all health and social care practitioners, teachers and counsellors to be educated about the full health impact of violence and abuse, and to be trained to explore these issues either as the true aetiology of the infant's ill-health, or as an underlying potentiating factor that has contributed to it. Nurses, midwives and health visitors as well as specially trained safeguarding nurse practitioners need to develop an early trusting relationship with parents and other family members to promote sensitive, empathic care of their infant. Nursery school nurses also have a key role in the identification of infants who may have been abused or are at risk of abuse. More and better training is needed to assist health and social care professionals in making appropriate use of core assessments and the common assessment framework (CAF) to support abused and neglected infants, and to ensure appropriate decisions are made about when to intervene. The availability of appropriate treatments to meet the needs of these infants, however, still remains a challenge [140]. Developing effective interventions and services is vital in order to support parents in meeting their children's health and wellbeing needs. A radical rethink of early intervention services is underway, blueprints for integrated working are being developed, bringing with them the opportunity to deliver meaningful and long term changes to the lives of young children across the country. Primary prevention efforts could thus be marketed universally, to further reduce the stigma associated with 'parent training': every parent can benefit from parent skills training, not just the 'bad' ones.

Concerns over inadequate record keeping, poor information sharing, and communication have also been raised by the Commission for Health Improvement [141] between NHS organizations and other agencies with respect to violence and abuse [142]. Developing a system that allows the sharing of information and statistics on abuse would immensely benefit professionals and the families with which they work, as it could provide interpretation of the multiple contributing factors associated with domestic and child abuse. This information would provide baselines to establish education, prevention and treatment programmes [112], to formulate benchmarks for performance evaluation, as well as allow professionals to collaborate and provide assistance and protection to victimized children in a more efficient and effective way. As Lord Laming states in his report:

*"Improvements to the way information is exchanged within and between agencies are imperative if children are to be adequately safeguarded. Effective action designed to safeguard the well being of children and families depends upon the sharing of information on a multi-professional, inter-agency basis [143]."* 

Finally the co-occurrence of risk factors for violence in pregnancy, where the health and safety of two potential victims are placed in jeopardy [53, 54, 55] stresses the importance for all health professionals and the primary care team to be able to recognize and report domestic and/or child abuse at this time Identifying domestic abuse, however, may be a useful risk factor for recognizing child abuse, which is clearly within the appropriate domain of professionals working in maternity or primary care services. Although tensions between the 'best interests of the mother' and the 'best interests of the child' are not always easily responded to, Fleck-Henderso n [144] suggests that best practices for families, where both children and women are at risk of violence, requires professionals to 'see double;' drawing from the knowledge and values of both perspectives to best meet the needs of these families. 'Seeing double' should therefore apply to all professionals in every child abuse case involving domestic violence.

## **Author details**

52 Child Abuse and Neglect – A Multidimensional Approach

willing to work across traditional boundaries.

preventative agenda.

response to be effective, all professionals need greater exposure to and familiarity with recommended good practice; and must be able to identify and support women and children who are experiencing abuse with a joined-up approach that has adequate resources and support of health service managers. Close inter-agency liaison is required with professionals who are accountable and not afraid to challenge historical working practices, and who are

Importantly evidence shows it is possible to prevent abuse and neglect and that the pregnancy and infancy offer a unique window of opportunity to work effectively with families at risk. Although we know that sustained maltreatment can have major long-term effects on all aspects of children's health and mental wellbeing, and impair their functioning as adults [81], many health professionals still remain unaware of these longterm health and wellbeing impacts on infants and younger children [119]. We know that the earliest years of life are a critical period when infants are making socio-emotional attachments and forming the crucial first relationships which lay the foundations for future health and wellbeing [84]. All types of maltreatment can affect an infant's emotional, psychological and mental wellbeing, and these consequences may appear immediately or years later. Enhancing the prospects for healthy development in the lives of maltreated infants therefore requires attention to enhancing opportunities for positive, non-violent family and peer interactions. The evidence tells us that pregnancy and the first year of life is a window of opportunity for preventive interventions and a crucial time to reduce later emotional, psychological and developmental difficulties, and develop stronger infant-parent relationships. The importance of preventing child maltreatment and thereby its short and long-term developmental, health and mental health consequences cannot be underestimated. Whilst efficiency savings are clearly key drivers behind much of the recent 'Early Years' policy developments in the UK, it is also clear that there are great opportunities to rethink and redesign how we support parents of very young children. How midwifery, obstetrics, paediatrics, social care, education and criminal justice professionals develop mechanisms for sharing resources and working together creatively to meet the needs of families will be central to the success of this

Given new evidence that trauma in pregnancy and infancy alters the physiology of the brain, it is time for all health and social care practitioners, teachers and counsellors to be educated about the full health impact of violence and abuse, and to be trained to explore these issues either as the true aetiology of the infant's ill-health, or as an underlying potentiating factor that has contributed to it. Nurses, midwives and health visitors as well as specially trained safeguarding nurse practitioners need to develop an early trusting relationship with parents and other family members to promote sensitive, empathic care of their infant. Nursery school nurses also have a key role in the identification of infants who may have been abused or are at risk of abuse. More and better training is needed to assist health and social care professionals in making appropriate use of core assessments and the common assessment framework (CAF) to support abused and neglected infants, and to

Anne Lazenbatt *NSPCC Reader in Childhood Studies, School of Sociology, Social Policy and Social Work, Queen's University of Belfast, Northern Ireland, UK* 

### **12. References**

[1] Flaherty, E.G., Sege R.D, Hurley T.P. (2009) Effect of early childhood adversity on health, *Archives of Paediatrics and Adolescent Medicine*, 160: 1232-1238.

Recognizing the Co-Occurrence of Child and Domestic Abuse in Pregnancy and the First Postnatal Year 55

[18] Thiara, R.K. and A.K. Gill (eds) (2010) Violence Against Women in South Asian

[19] Abramsky, Tanya, Charlotte H. Watts, Claudia Garcia-Moreno, Karen Devries, Ligia Kiss, Mary Ellsberg, Henrica A. F. M. Jansen, and Lori Heise. (2011). "What Factors Are Associated With Recent Intimate Partner Violence? Findings from the WHO Multi-Country Study On Women's Health and Domestic Violence." *BMC Public Health* 11: 109-

[20] Hester *et al.*, 2007 Hester (2007) Asking about domestic violence: implications for practice. In: C. Humphreys, & N. Stanley (eds). *Domestic violence and child protection:* 

[21] McGee C. (2000) Childhood experiences of domestic violence, *Adoption and Fostering*, 20:

[22] Osofsky JD. (2003) Prevalence of children's exposure to domestic violence and child maltreatment: implications for practice and intervention, *Clinical Child & Family* 

[23] Osofsky J.D., Hammer J.H., Freeman N. & Rovaris J.M. (2004) How law enforcement and mental health professionals can partner to help traumatized children. In: J.D. Osofsky (Ed.) *Young Children and Trauma: Intervention and Treatment*, pp. 285–298.

[24] Mullender, A., Burton, S., Hague, G., Imam, U., Kelly, L., Malos, E., & Regan, L. (2003). ''StopHitting Mum!'': Children talk about domestic violence. East Molesey, Surrey:

[25] Mullender 2004, Mullender A. (2004) Tackling Domestic Violence: providing support for children who have witnessed domestic violence, Home Office Practice and Development Report 33, London, Home Office. View the report at the Home Office

[26] Mullender, A. (2005) '*What children tell us: "He said he was going to kill our mum"* ', in

[27] Humphreys C., Thiara R.K., Skamballis A. & Mullender A. (2006) T*alking about Domestic Abuse: A Photo Activity Workbook to Develop Communication Between Mothers and Young* 

[28] Mian A.I. (2005) Depression in pregnancy and the postpartum period: balancing adverse effects of untreated illness with treatment risks. *Journal of Psychiatric Practice* 11,

[29] Radford L., Blacklock N. & Iwi K. (2006) 'Domestic violence risk assessment and safety planning in child protection - Assessing perpetrators' in C Humphreys and N Stanley (eds) *Domestic Violence and Child Protection: Directions for good practice*. London: Jessica

[31] Radford L, Corral, S. Bredley, C. Fisher, H, Bassett, C. Collishaw, S. (2011) *Child Abuse* 

[32] Abrahams, C (1994) *Hidden Victims: Children and Domestic Violence,* London: NCH Action

Humphreys, C. and Stanley, N. (eds) (2005) London, Jessica Kingsley.

[30] Department of Health (2002) *The Children's Act Report*. HMSO,London.

*and Neglect in the UK Today;* NSPCC: London.

Communities: Issues for Policy and Practice , Jessica Kingsley Publishers.

*directions for good practice*. London: Jessica Kingsley.

*Psychology Review,* 6(3): 161-170.

*People*, London, Jessica Kingsley

Guilford Press, New York.

Young Voice.

website.

389–396.

Kingsley.

for Children.

125.

8-15.


[18] Thiara, R.K. and A.K. Gill (eds) (2010) Violence Against Women in South Asian Communities: Issues for Policy and Practice , Jessica Kingsley Publishers.

54 Child Abuse and Neglect – A Multidimensional Approach

[1] Flaherty, E.G., Sege R.D, Hurley T.P. (2009) Effect of early childhood adversity on

[3] Smith, Kevin (ed.) et al (2011) *Homicides, firearms offences and intimate violence 2009/2010: supplementary volume 2 to crime in England and Wales 2009/2010.* London: Home Office. [4] Putnam-Hornstein, EP; Webster, D; Needell, B; Magruder, J. (2011) A Public Health Approach to Child Maltreatment Surveillance: Evidence from a Data Linkage Project in

[6] *Ofsted (2011) Ages of concern: learning lessons from serious case reviews: a thematic report of Ofsted's evaluation of serious case reviews from 1 April 2007 to 31 March 2011*. Ofsted:

[7] World Health Organization (2002) *World Report on Violence and Health,* World Health

[8] Krug, E. G. Mercy, JA. Dahlberg, LL. Zwi, AB. (2002) The world report on violence and

[9] Coker AL, Davis KE, Arias I. (2002) Physical and mental health effects of intimate partner violence, for men and women, *American Journal of Preventive Medicine;* 23:260–8. [10] Department of Health (2010) *Responding to Violence Against Women and Children – the role of the NHS,* The report of the Taskforce on the Health Aspects of Violence Against

[11] Pico-Alfonso M.A. Garcia-Linares M.I. CelDV-Navarro N. (2005) The impact of physical, psychological, and sexual intimate male partner violence on women's mental health: depressive symptoms, posttraumatic stress disorder, state anxiety, and suicide.

[12] Walby and Allen, 2004 Walby S. & Allen J. (2004) *Domestic Violence, Sexual Assault and Stalking: Findings from the British Crime Survey*, Home Office Research Study 276,

[13] Garcia Moreno, Claudia (2003) "Responding to Violence Against Women: WHO's Multi-Country Study on Women's Health and Domestic Violence." *Health and Human* 

[14] Coleman, K, Jansson, K, Kaiza, P. and Reed, E. (2007) *Homicides, Firearm Offences and Intimate violence 2005/6: Supplementary Volume 1 to Crime in England and Wales 2005-6)* 

[15] Smith, K. (ed), Coleman, K, Eder, S and Hall, P (2011) Homicides, firearm offences and intimate violence 2009/10 (Supplementary volume 2 to Crime in England and Wales

[16] Gielen AC., O'Campo PJ., Faden RR., Kass NE., Xue X. (1994) Interpersonal conflict and physical violence during the childbearing year, *Social Science & Medicine* 39, 781-7. [17] Coker, A., Sanderson, M., & Dong, B. (2004). Partner violenceduring pregnancy and risk of adverse pregnancy outcomes. *Paediatrics and Perinatal Epidemiology, 18,* 260-269.

(Home Office Statistical Bulletin 02/07, Office for National Statistics)

2009/10 2nd Edition). Home Office Statistical Bulletin 01/11.

health, *Archives of Paediatrics and Adolescent Medicine*, 160: 1232-1238. [2] Osofsky JD, Lieberman AF. (2011) *American Psychologist* Feb-Mar; 66(2): 120-28

[5] Manning, V. (2011) *National Psychiatric Morbidity Survey*, NSPCC: London.

the United States, *Child Abuse Review,*20: 4, p.231-306.

Women and Children: London: Department of Health.

**12. References** 

London.

Organisation, Geneva.

London: Home Office.

*Rights* 6(2): 112-127.

health. *Lancet*, *5,* 1083-1088.

*Journal of Women's Health* 15, 599–611.

	- [33] Brookoff, D, O'Brien, K, Cook, C, Thompson, T and Williams, C (1997) Characteristics of Participants in Domestic Violence. Assessment at the Scene of Domestic Assault, *The Journal of the American Medical Association*, Vol. 277, No. 17, pp1369-1373.

Recognizing the Co-Occurrence of Child and Domestic Abuse in Pregnancy and the First Postnatal Year 57

[49] Lewis, Gwynneth, Drife, James. et al (2001) Why Mothers Die: Report from the confidential enquiries into maternal deaths in the UK 1997-9; commissioned by

[50] Campbell, J; García-Moreno, C; Sharps, P. (2003) Abuse During Pregnancy in Industrialized and Developing Countries, *Violence Against Women,* Vol. 10, No. 7, 770-

[51] Lewis, Gwynneth, and Drife, James. et al (2005) Why Mothers Die 2000-2002 - Report on confidential enquiries into maternal deaths in the United Kingdom (CEMACH). [52] Jasinski JL. (2004) Pregnancy and domestic violence: a review of the literature. *Trauma* 

[54] Mezey, GC., Bacchus L., Haworth A. et al. (2003) Midwives' perceptions and experiences of routine enquiry for domestic violence. *British Journal of Obstetrics &* 

[55] Mezey GC., Bacchus L., Bewley S. et al. (2005) Domestic violence, lifetime trauma and psychological health of childbearing women *British Journal of Obstetrics & Gynaecology:* 

[56] Mezey GC. & Bewley S. (1997) Domestic violence and pregnancy. *British Medical Journal,* 

[57] Shumway J, O'Campo P, Gielen, A. et al (1999) Preterm labour, placental abruption and premature rupture of membranes in relation to maternal violence or verbal abuse. *The* 

[58] Goodall E & Lumley T (2007) '*Not seen and not heard' – child abuse: a guide for donors and* 

[59] Lucas DR., Wezner K., Milner JS., McCanne T., Harris C., Monroe-Posey & Nelson JP. (2002) Victim, perpetrator, family, and incident characteristics of infant and child

[61] Hartley CC. (2002) The co-occurrence of child maltreatment and domestic violence: examining both neglect and child physical abuse, *Child Maltreatment*, 7, 4: 349-358. [62] Cicchetti D, Rogosch FA, and Toth, SL (2006) Fostering secure attachment in infants in maltreating families through preventative interventions; *Development and* 

[63] Glaser D. (2007) The effects of child maltreatment on the brain. *The Link: The Official Newsletter of the International Society for the Prevention of Child Abuse and Neglect*; 16(2):1-4. [64] Glaser D. (2002) Emotional abuse and neglect (psychological maltreatment): a

[65] Hesse E, Main M. (2006)*Frightened, threatening, and dissociative parental behavior in lowrisk samples: Description, discussion, and interpretations. Development and Psychopathology* 

homicide in the United States Air Force. *Child Abuse & Neglect* 26, pp. 167–186. [60] Edleson, JL. (2001) Studying the co-occurrence of child maltreatment and woman battering in families. In SA Graham-Bermann and JL Edleson (Eds.), *Domestic violence in the lives of children: The future of research, intervention and social policy*. (pp. 99-110)

[53] McWilliams M, & McKiernan J. (1993) *Bringing it out into the open,* Belfast HMSO.

*An International Journal of Obstetrics & Gynaecology*. 112(2):197-204.

Department of Health from RCOG and NICE (London: RCOG Press).

789.

314: 1295.

*Violence Abuse*, 5(1): 47-64.

*Gynaecology,* Vol 110, 8: 744-752.

*Psychopathology,* 18, 623-649.

*2006;18:309-343.*

*Journal of Maternal-Foetal Medicine*, 8(3): 76-80.

*funders*, New Philanthropies Capital: London.

Washington, DC: American Psychological Association.

conceptual framework. *Child Abuse Neglect*; 26: 697–714.


[49] Lewis, Gwynneth, Drife, James. et al (2001) Why Mothers Die: Report from the confidential enquiries into maternal deaths in the UK 1997-9; commissioned by Department of Health from RCOG and NICE (London: RCOG Press).

56 Child Abuse and Neglect – A Multidimensional Approach

*Violence Against Women* 5, 134–154.

*Abuse* and Neglect, Vol. 20, pp589-98.

*Association Journal*, 149: 1257 - 1263.

*Gynecology* 195, pp. 140–148.

*and Gynaecology*, 109: 9-16.

Aid Federation: Belfast.

*Kingdom* (CEMACH).

Trauma Violence Abuse, 5(1), 47-64.

Health Organisation: Copenhagen.

60(1), 11-13.

275: 1915-1920.

against women.

*Journal* 324, 1-6.

[33] Brookoff, D, O'Brien, K, Cook, C, Thompson, T and Williams, C (1997) Characteristics of Participants in Domestic Violence. Assessment at the Scene of Domestic Assault, *The* 

[34] Edelson J. (1999) The overlap between child maltreatment andwoman battering.

[35] Ross, S (1996) 'Risk of Physical Abuse to Children of Spouse Abusing Parents', *Child* 

[36] Stewart DE. & Cecutti A. (1993) Physical abuse in pregnancy. *Canadian Medical* 

[37] Silverman MR., Decker E., Reed A. & Raj A. (2006) Intimate partner violence victimization prior to and during pregnancy among women residing in 26 U.S. states: associations with maternal and neonatal health, *American Journal of Obstetrics &* 

[38] Shadigian EM. & Bauer ST. (2004) Screening for partner violence during pregnancy.

[39] Bacchus L., Mezey G., Bewley S. (2002) Women's perceptions and experiences of routine enquiry for domestic violence in a maternity service. *British Journal of Obstetrics* 

[40] Craig C. (2003) *Domestic Violence and Health Professionals*. Northern Ireland Women's

[41] Confidential enquiry into maternal and child health for England and Wales (2004) *Why Mothers Die 2000-2002 - Report on confidential enquiries into maternal deaths in the United* 

[42] Bacchus, L., Mezey, G., & Bewley, S. (2005). Prevalence of domestic violence when midwives routinely enquire in pregnancy. Obstetrical and Gynaecological Survey,

[43] Jasinski, J. L. (2004). Pregnancy and domestic violence: A review of the literature.

[44] Gazmararian JA, Lazorick S, Spitz AM. et al (1996) Prevalence of Violence Against Pregnant Women: A Review of the Literature. *Journal of the American Medical Association,*

[45] Gazmararian JA et al (2000) Violence and reproductive health; current knowledge and future research directions. Maternal and Child Health Journal 4: 79-84. As quoted in: Family Violence Prevention Fund. The facts on reproductive health and violence

[46] World Health Organization (2000) *Violence against women,* Factsheet No 239, World

[47] Lemon SC., Verhoek-Oftedahl W.,& Donnelly EF. (2002) Preventive healthcare use, smoking, and alcohol use among Rhode Island women experiencing intimate partner

[48] Richardson J., Coid J., Petruckevitch A., Chung WS., Moorey S. & Feder G. (2002) Identifying domestic violence: cross sectional study in primary care. *British Medical* 

violence. *Journal of Women's Health & Gender-Based Medicine* 11(6), 555-62.

*International Journal of Gynaecology & Obstetrics,* 84(3): 273-280.

*Journal of the American Medical Association*, Vol. 277, No. 17, pp1369-1373.

	- [66] Jordan B, Sketchley R (2009) *A stitch in time saves nine: Preventing and responding to the abuse and neglect of infants* (NCPC Issues No. 30). Melbourne: National Child Protection Clearinghouse.

Recognizing the Co-Occurrence of Child and Domestic Abuse in Pregnancy and the First Postnatal Year 59

[82] Kendall-Tackett K.A. (2003) Treating the lifetime health effects of childhood

[83] Teicher MD (2000) Wounds that time won't heal: The neurobiology of child abuse.

[84] Bowlby R, King P (2004) *Fifty Years of Attachment Theory: Recollections of Donald Winnicott* 

[85] Belsky, J., Houts, R.M. & Fearon, R.M.P. (2010) Infant Attachment Security and Timing of Puberty: Testing an Evolutionary Hypothesis. *Psychological Science,* 21, 1195-1201. [86] Balbernie, R. (n.d.). *Early intervention services: An overview of evidence-based practice*.

[87] Schore, A. N. (2003) Early relational trauma, disorganized attachment, and the development of a predisposition to violence. In M. F. Solomon and D. J. Siegel (Eds.),

[88] Kendall-Tackett KA. (2001) Physiological correlates of childhood abuse: chronic hyperarousal in PTSD, depression, and irritable bowel syndrome*. Child Abuse Neglect*;

[89] Hunt S. & Martin A. (2001) *Pregnant women, violent men: what midwives need to know.*

[90] Hobbs, GF, & Hobbs, CJ. (1999) Abuse of children in foster and residential care. *Child* 

[91] Campbell J. & L. Lewandowski, L. (1997) Mental and physical health effects of intimate partner violence on women and children, *The Psychiatric Clinics of North America* 20, pp.

[92] Tuten, M; Jones,HE; Tran, G and Svikis, DS. (2004) Partner violence impacts the psychosocial and psychiatric status of pregnant, drug-dependent women, *Addictive* 

[93] Sandman CA, Wadhwa PD, Chicz-DeMet A, Dunkel-Schetter C, Porto M. (2007) Maternal stress, HPA activity, and fetal/infant outcome. *Annals of New York Academy* 

[94] Dietz, PM., Gazmararian, JA., Goodwin, M., Bruce, FC., Johnson, CH., & Rochat, R. (1997) Delayed entry into prenatal care: the effects of physical violence. *Obstetrics &* 

[95] Goodwin, M., Gazmararian, J. A., Johnson, C. H., Gilbert, B. C., Saltzman, L. E., & Group, P.W. (2000). Pregnancy intendedness and physical abuse around the time of pregnancy: Findings from the Pregnancy Risk Assessment Monitoring System, 1996-

[96] McFarlane, J., Campbell, J. C., Sharps, P., & Watson, K. (2002) Abuse during pregnancy

[98] Norton, L. B., Peipert, J. F., Zierler, S., Lima, B., & Hume, L. (1995).Battering in pregnancy: An assessment of two screening methods Obstetrics and Gynecology, 85,

*Healing trauma: Attachment, mind, body, and brain.* New York, NY: Norton.

victimization Kingston, NJ: Civic Research Institute Inc.

*Cerebrum: The Dana Forum on brain science*, 2(4): 50-67.

Retrieved August, 2008, from www.waimh.org

*and John Bowlby*. London: Allen Press.

Books for Midwives Press: Hale.

*Behaviors* 29, pp. 1029–1034.

*Gynaecology,* 90 (2), 221-224.

1997. *Maternal and Child Health Journal*, *4*(2), 85-92.

and femicide. *Obstetrics & Gynecology*, *100*, 27-36. [97] (Domestic Violence, Crime and Victims Act, 2004

*Sci*ence 814:266–275.

*Abuse Neglect,* Dec, 23(12):1239–1252.

24(6):799-810.

353–374.

321-325.


[82] Kendall-Tackett K.A. (2003) Treating the lifetime health effects of childhood victimization Kingston, NJ: Civic Research Institute Inc.

58 Child Abuse and Neglect – A Multidimensional Approach

and neglect. *Trauma Violence Abuse*; 10:389-410.

*and Neglect in the UK Today;* NSPCC: London.

Public Health Nursing 16, 359–366.

doi:10.1177/0886260510362883

*Lifestyle Medicine;* 5(5): 392-406.

*Psychiatrica Scandinavica,* 118:281–90.

*Psychiatry*; 56(2):80-5.

24(6):799-810.

*Development and Psychopathology,* 13(3), 539–564.

and child maltreatment*. Current Psychiatry Reports*, 5: 108-117.

Clearinghouse.

*Wave Trust: UK.*

13: 783-804.

[66] Jordan B, Sketchley R (2009) *A stitch in time saves nine: Preventing and responding to the abuse and neglect of infants* (NCPC Issues No. 30). Melbourne: National Child Protection

[67] Neigh GN, Gillespie CF, Nemeroff CB. (2009) The neurobiological toll of child abuse

[68] Radford L, Corral, S. Bredley, C. Fisher, H, Bassett, C. Collishaw, S. (2011) *Child Abuse* 

[69] Hosking, G and Walsh, I (2005) *The Wave Report 2005. Violence and What to Do about It,* 

[70] Schore, A N. (2003) Early relational trauma, disorganized attachment, and the development of a predisposition to violence. In M. F. Solomon and D. J. Siegel (Eds.),

[71] Shepard, M.F., Elliott, B.A., Falk, D.R., et al., 1999. Publichealth nurses' responses to domestic violence: a report fromthe Enhanced Domestic Abuse Intervention Project.

[72] Sousa, C., Herenkhol, T. I., Moylan, C. A., Tajima, E. A., Klika, J. B., Herenkohl, R. C., Russo, M. J (2011) Longitudinal study on the effects of child abuse and children's exposure to domestic violence, parent-child attachments, and antisocial behavior in adolescence. *Journal of Interpersonal Violence, 26*(1), 111-136*.*

[73] De Bellis MD. (2001) Developmental traumatology: The psychobiological development of maltreated children and its implications for research, treatment, and policy.

[74] De Bellis, M., and Thomas, L. (2003) Biologic findings of post-traumatic stress disorder

[75] Cicchetti, D., and Rogosch, F.A. (2001) The impact of child maltreatment and psychopathology upon neuroendocrine functioning*. Development and Psychopathology*,

*[76]* Haegerich TM, Dahlberg LL. (2011) Violence as a Public Health Risk, *American Journal of* 

[77] Schore, A N. (2003) Early relational trauma, disorganized attachment, and the development of a predisposition to violence. In M. F. Solomon and D. J. Siegel (Eds.),

[80] Weniger G, Lange C, Sachsse U, Irle E (2008) Amygdala and hippocampal volumes and cognition in adult survivors of childhood abuse with dissociative disorders. *Acta* 

[81] Kendall-Tackett K.A. (2001) Physiological correlates of childhood abuse: chronic hyperarousal in PTSD, depression, and irritable bowel syndrome. *Child Abuse Neglect*;

*Healing trauma: Attachment, mind, body, and brain.* New York, NY: Norton. [78] De Bellis MD. (2005) The psychobiology of neglect*. Child Maltreatment*; 10 (2):150-72. [79] Teicher M.H., Dumont N.L., Ito Y., Vaituzis C., Giedd J.N., Andersen S.L. (2004) Childhood neglect is associated with reduced corpus callosum area. *Biological* 

*Healing trauma: Attachment, mind, body, and brain.* New York, NY: Norton.

	- [99] Coker, AL; Sanderson, M; & Dong, B. (2004) Partner violence during pregnancy and risk of adverse pregnancy outcomes, *Paediatric and Perinatal Epidemiology,* 18, 260–269.

Recognizing the Co-Occurrence of Child and Domestic Abuse in Pregnancy and the First Postnatal Year 61

[117] Lupton, N. North, I. & Khan, N. (2001) Working together or pulling apart? The National Health Service and child protection networks, The Policy Press: Bristol. *[118]* Lazenbatt A. & Freeman R. (2006) Recognizing and reporting child physical abuse: a cross sectional survey of primary health care professionals, *Journal of Advanced Nursing,* 

[119] Department for Education and Skills (2004) National Service Framework for Children, Young People and Maternity Services: Core Standards. London: Department of Health. *[120]* Department for Education and Skills (2006) *Working Together to Safeguard Children: A Guide to Inter-Agency Working to Safeguard and Promote the Welfare of Children* London:

[121] Bewley, S. (1997) Pregnancy and violence. In: Bewley, S. Friend, J. & Mezey, G. *Violence* 

[122] Lazenbatt A., Cree LF. & McMurray. (2005) The use of exploratory factor analysis in evaluating midwives' attitudes and stereotypical myths related to the identification and

[124] Lazenbatt A., Taylor J. & Cree L. (2008) A Healthy Settings Framework: an evaluation and comparison of midwives' responses to addressing domestic violence in pregnancy,

[125] Sinclair R. & Bullock R. (2002) *Learning from past experiences – a review of significant case* 

[126] Dale P., Green R. & Fellows R. (2002) *What Really Happened? - Child Protection Case Management of Young Children with Serious Injuries and Discrepant Parental Explanations.*

[127] Protheroe L., Green J. & Spiby H. (2001) An interview study of the impact of domestic

[128] Smith F. (2003) Safe-guarding the young, *Paediatric Nursing & Midwifery,* 15, 10:24-25. [129] Taket A., Nurse J., Smith K. et al. (2003) Routinely asking women about domestic

[130] Paluzzi PA. & Houde-Quimbly CH. (1996) Domestic violence Implications for the American College of Nurse-Midwives and Its Members. *Journal of Nurse-Midwifery,*

[131] Radford L., Blacklock N. & Iwi K. (2006) 'Domestic violence risk assessment and safety planning in child protection - Assessing perpetrators' in C Humphreys and N Stanley (eds) *Domestic Violence and Child Protection: Directions for good practice*. London: Jessica

[132] Department of Health (2006) Tackling the health and mental health effects of domestic

[133] Price, S. (2004) "Routine questioning about domestic violence in maternity settings" in

[134] Buck, L. (2007) Why don't midwives ask about domestic violence? *British Journal of* 

management of DV in practice, *Midwifery: an international journal*, 21, 322-334. [123] Peckover S. (2003) Health visitors' understanding of domestic violence. *Journal of* 

*56, 3: 227- 237.* 

*Midwifery*.

41(6): 430-435.

Kingsley.

Midwives, Vol.7, no.4 April.

*Midwifery*, Vol. 15, 12: 753 – 758.

Department of Health.

*against women.* RCOG Press: London.

*reviews,* The Stationary Office: London.

London: NSPCC Publications Unit.

violence training on midwives. *Midwifery,* 20(1): 94-103.

violence in health settings. *British Medical Journal,* 327: 673-676.

and sexual violence and abuse, London: Department of Health.

*Advanced Nursing,* 44(2), 200-8.


[117] Lupton, N. North, I. & Khan, N. (2001) Working together or pulling apart? The National Health Service and child protection networks, The Policy Press: Bristol.

60 Child Abuse and Neglect – A Multidimensional Approach

*domestic violence data.* London: NACRO.

doi:10.1177/0886260510362883

NSPCC Research Department: London.

*Violence* 21, pp. 652–672.

Fund.

*Journal*, 325:1-13.

with maternal health and infant birth, *Nursing*, pp. 37–42.

[99] Coker, AL; Sanderson, M; & Dong, B. (2004) Partner violence during pregnancy and risk of adverse pregnancy outcomes, *Paediatric and Perinatal Epidemiology,* 18, 260–269. [100] McFarlane, J., Parker, B. and Soeken, K. (1996a) Abuse during pregnancy: Associations

[101] McFarlane, J., Parker, B. and Soeken, K. (1996b) Physical abuse, smoking, and substance use during pregnancy: Prevalence, interrelationships, and effects on birth

[103] Hall, T. and Wright, S. (2003) *Making it count: A practical guide to collecting and managing* 

[104] Lundy M. & Grossman SF. (2005) The mental health and service needs of young

[105] Butchart A. & Villaveces A. (2003) *Violence against women and the risk of infant and child* 

[106] Mullender A., Burton S., Hague G., Imam U., Kelly L., Malos E. & Regan L. (2003) *'Stop Hitting Mum!': Children Talk about Domestic Violence*, East Molesey, Surry, Young Voice. [107] Sousa, C., Herenkhol, T. I., Moylan, C. A., Tajima, E. A., Klika, J. B., Herenkohl, R. C., Russo, M. J (2011) Longitudinal study on the effects of child abuse and children's exposure to domestic violence, parent-child attachments, and antisocial behavior in adolescence. *Journal of Interpersonal Violence, 26*(1), 111-136*.*

[108] Amaro H., Fried L E., Cabral H., Zuckerman B. (1990) Violence during pregnancy and

[109] Appel AE. & Holden GW. (1998) The co-occurrence of spouse and physical child

[110] Carter J. & Schechter S. (1997). Child abuse and domestic violence: Creating community partnerships for safe families-Suggested components of an effective child welfare response to domestic violence. San Francisco, CA: Family Violence Prevention

[111] Creighton S. (2004) *Prevalence and incidence of child abuse: international comparisons,*

[112] Mullender A., Burton S., Hague G., Imam U., Kelly L., Malos E. & Regan L. (2003) *'Stop Hitting Mum!': Children Talk about Domestic Violence*, East Molesey, Surry, Young Voice. [113] Filipas HH. and Ullman, SE (2006) Child sexual abuse, coping responses, self-blame, posttraumatic stress disorder, and adult sexual revictimization, *Journal of Interpersonal* 

[114] British Medical Association. (1998) *Domestic violence: a health care issue*? BMA: London. [115] Mullender, A. (2005) '*What children tell us: "He said he was going to kill our mum"* ', in

Humphreys, C. and Stanley, N. (eds) (2005) London, Jessica Kingsley. [116] Department of Health. (2002) *The Children's Act Report.* London: HMSO.

children exposed to domestic violence, *Families and Sociology*, 86(1):17-29.

*mortality*, Bulletin of the World Health Organization: Geneva.

substance use, *American Journal of Public Health,* 80 (5), 575-579.

abuse: a review and appraisal. *Journal of Family Psychology*;12:578–99.

weight, *Journal of Obstetric, Gynecologic, and Neonatal Nursing* 25, pp. 313–320. [102] Ramsay J., Richardson J., Carter YH., Davidson L. & Feder G. (2002). Should health professionals screen women for domestic violence? Systematic review. *British Medical* 

	- [135] Hunter B. (2004) Conflicting ideologies as a source of emotion work in midwifery. *Midwifery*, 20: 261-272.

**Chapter 4** 

© 2012 Cyr et al., licensee InTech. This is an open access chapter distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2012 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

**Attachment Theory in the Assessment and** 

Caroline Poulin, Katherine Pascuzzo, Valérie Losier, Marilyne Dumais,

Maltreatment is a complex problem affecting the lives of thousands of families and children. In fact, not only is maltreatment a major societal issue carrying substantial socio-economic costs in relation to medical and social allowances, but it also has devastating effects on child development. There is thus a pressing need to better understand the dysfunctional interactions occurring between abusive/neglecting parents and their children in order to improve evaluation and intervention strategies with these families. In the past few years, attachment theory has provided a solid foundation for understanding the risk and resiliency factors involved in the development of maltreated children and guided the development of assessment and intervention protocols for this at-risk population. Attachment theory and related empirical studies thus provide relevant knowledge about the processes through which maltreatment may negatively impact child development, as well as the clinical applications and

According to the ecological-transactional perspective child attachment is an important protective factor for the development of children with a history of abuse and neglect [1]. More precisely, this perspective [2]sustains that maltreated children's adaptation is affected by several systemic levels, some closer to the child such as the system including family relationships, and others more distal, such as the community and cultural values systems. Though the ecological-transactional model acknowledges the influence of different systemic levels, systems closest to the child are considered has having the greatest impact on child development. Problematic and dysfunctional parent-child interactions, which are characteristic of families subject to maltreatment, have a more direct effect on child

and reproduction in any medium, provided the original work is properly cited.

**Promotion of Parental Competency** 

Chantal Cyr, Karine Dubois-Comtois, Geneviève Michel,

**in Child Protection Cases** 

Additional information is available at the end of the chapter

Diane St-Laurent and Ellen Moss

best-suited practices for this population.

http://dx.doi.org/10.5772/48771

**1. Introduction** 


**Chapter 4** 
