Recently released national research showed that one in sixteen adolescent girl’s first sexual experience is rape. In a new Denver Post Guest Commentary, Anne DePrince talks about the messages conveyed when violence is so common. And the messages we need to send instead.
by Anne P. DePrince & Julia Dmitrieva
Following child abuse and neglect allegations, investigations can involve multiple systems and people from child welfare, criminal justice, and health agencies. Complex multi-system investigations can leave caregivers confused, intimidated, or alienated, which can decrease their engagement with child welfare action plans (Staudt, 2007). Decreased caregiver engagement can negatively affect child outcomes, including increasing out-of-home placements (Dawson & Berry, 2002). Therefore, policy-makers and practitioners have called for multidisciplinary teams (MDTs) to work together across the investigation. As communities begin to establish or seek to improve MDTs, hearing directly from caregivers about their perceptions of investigations is important to ensuring practices support children and families. We set out to learn directly from caregivers about their views of child abuse and neglect investigations involving MDTs.
…policy-makers and practitioners have called for multidisciplinary teams (MDTs) to work together across the investigation.
Between January and June, our team interviewed 32 caregivers involved in child abuse and neglect investigations. Half of the caregivers interviewed indicated that they were the subject of the investigation; half were not. Caregivers were asked to share their perspectives on several topics. For example, what did they see as their role in the investigation? What did people involved in the investigation do to communicate support-validation-respect or lack of support-invalidation-disrespect?
We are learning several important things from caregivers. Here are our take-aways from preliminary analyses:
Caregivers Believe Coordination Matters. Caregivers frequently conveyed their beliefs that investigation outcomes depend on the coordination and communication of the MDT. Therefore, MDTs may want to take opportunities to clearly communicate to families who is on the team and how they work together, including how they communicate with one another. By emphasizing and explaining the collaboration, providers may be able to show their alignment with caregiver beliefs that coordination matters for outcomes. Providing information verbally and in writing about who their team members are from across the disciplines may support caregiver acquisition of that information during what can be a stressful time. Further, MDTs might consider how they communicate the caregiver’s role in the investigation and take steps to reinforce the messages given to caregivers.
Communication with Caregivers is Critically Important. Across interviews, we heard over and over about the importance of clear communication with families, during the initial days when the investigation begins as well as over time. Communication was central to caregiver perceptions of both support and respect when communication went well — and drove perceptions of lack of support and disrespect when communication faltered. Caregivers pointed to specific communication actions that made them feel supported and validated, such as returning phone class and providing regular and timely updates on the investigations. In addition, caregivers also felt supported when MDT members listened, explained steps in the investigation, answered questions, and conveyed belief (versus treating caregivers like “criminals”), empathy, and encouragement.
Though some caregiver concerns may fall outside the control of the MDT, clear communication with families may help nonetheless. For example, more than a third of participants expressed frustrations around issues related to the tensions between criminal and civil legal systems (e.g., protection orders), inaccessible language used in the investigations, and lack of offender accountability. While the MDT cannot control consequences for offenders, the team can play an active role in educating families about the criminal justice process, including terms used and timelines.
Keep the Brain in Mind. The majority of caregivers interviewed had their own histories of experiencing intimate violence by someone close, such as a caregiver or partner. Histories of intimate violence can make attention and memory as well as emotion regulation tasks difficult (e.g., Stein, Kennedy, & Twamley, 2002; Twamley et al., 2009). The onset of a child abuse and neglect investigation is stressful, whether an allegation is leveled against the caregiver or someone else. The multi-system response is confusing to understand. This context, combined with feedback from caregivers, suggests that teams responding to child abuse and neglect investigations should plan for challenges related to attention and memory, confusion about systems and roles, complex emotions, and prior experiences and expectations. MDTs might consider providing communications in multiples forms (for example, in writing and verbally) and plan to repeat communications.
Recognize the Unique Strengths and Challenges Facing Families. Half of participants described concerns about actions that were dismissive of the caregiver, and one in five described feeling as if the team was insensitive. This is consistent with other research on sexual assault survivors’ perceptions of victim services (including criminal justice) (Gagnon et al., 2018). In that work with sexual assault survivors, we learned that their perceptions of criminal justice and health-related services often started in the waiting room (Wright & DePrince, 2018). MDTs serving children may have similar opportunities to set the stage for the investigation in ways that emphasize family privacy in the waiting room (e.g., in how families sign-in) and center the child (e.g., in the degree to which the room is child-friendly).
Communities seeking to increase collaboration among agencies responding to child abuse and neglect allegations should prioritze:
- explaining how agencies will work together during the investigation;
- clear and regular communications with caregivers;
- strategies that convey support, such as listening and offering resources;
- recognize the unique strengths and challenges facing individual families.
This research was supported by the Colorado Evaluation and Action Lab of the University of Denver. The opinions expressed are those of the authors and do not represent the views of the Colorado Lab or the University of Denver. Thank you to our government partners as well as as members of the Traumatic Stress Studies Group, especially graduate student researchers Maria-Ernestina Christl, Julie Olomi, Adi Rosenthal, and Naomi Wright; and research assistants Margaret Port, Francesca Dino, Hannah Branit, Avery Stackle, Madison Hakey, Sandra Dominguez, Veronique Calmels, and Halley Pradell.
Dawson, K., & Berry, M. (2002). Engaging families in child welfare services: An evidence-based approach to best practice. Child Welfare, 81(2), 293-317.
Gagnon, K.L., Wright, N., Srinivas, T., & DePrince, A.P. (2018). Survivors’ Advice to Service Providers: How to Best Serve Survivors of Sexual Assault. Journal of Aggression, Maltreatment & Trauma, 27(10), 1125-1144. doi: 10.1080/10926771.2018.1426069
Staudt, M. (2007). Treatment engagement with caregivers of at-risk children: Gaps in research and conceptualization. Journal of Child and Family Studies, 16(2), 183-196.
Stein, M. B., Kennedy, C. M., & Twamley, E. W. (2002). Neuropsychological function in female victims of intimate partner violence with and without posttraumatic stress disorder. Biological Psychiatry, 52(11), 1079-1088.
Twamley, E. W., Allard, C. B., Thorp, S. R., Norman, S. B., Cissell, S. H., Berardi, K. H., … & Stein, M. B. (2009). Cognitive impairment and functioning in PTSD related to intimate partner violence. Journal of the International Neuropsychological Society, 15(6), 879-887.
Wright, N. & DePrince, A.P. (2018, December 10). Victim Services Start in the Waiting Room [Blog post]. Retrieved from //traumaresearchnotes.blog/2018/12/10/victim-services-start-in-the-waiting-room/
Julia Dmitrieva & Anne P. DePrince
Child abuse and neglect investigations can span multiple systems, from child welfare and health to criminal justice. Given the complexity of such multi-system responses, practitioners and policy makers have called for personnel from different systems to coordinate their investigations and responses to families through multidisciplinary teams (MDTs).
Unfortunately, little research is available to guide policy and practice for communities considering MDT responses to child abuse and neglect allegations. Available research has tended to focus on child advocacy center responses (e.g., Brink et al., 2015). We set out to address this research gap by testing the impact of a MDT on case outcomes following child abuse and neglect allegations.
Here’s what we learned.
In a single urban county, we worked with government partners to analyze de-identified administrative data on child abuse and neglect referrals from January 2017 to September 2018. From the administrative data, we identified 1,237 cases that involved a MDT in the investigation, including child welfare workers, police, and forensic medical providers. We then identified 1,237 cases that did not involve the MDT, but were matched to the MDT cases in terms of the referral allegation (for example, physical abuse) and referral source (for example, whether the referral came from a mandated reporter).
When we compared case outcomes and the investigations, several important differences stood out. Relative to the control cases, MDT cases
- Were 3 times more likely to result in substantiated allegations.
- Took on average 1.72 days longer to investigate than control cases.
- Had more documented contacts during the investigation. The differences were especially striking for face-to-face contacts, suggesting that multidisciplinary teams have more opportunities to engage with families.
- Resulted in more out-of-home placements in the first 90 days after the referral allegation.
This research suggests that professionals working within a MDT to respond to child abuse and neglect allegations do their work differently than those working independently. The investigations involve more contacts and take longer, perhaps reflecting the time required for additional coordination and sharing of information. With higher rates of substantiation and more face-to-face contacts, opportunities expand for MDTs to turn their attention, then, to supporting child victims and their families in healing and safety.
These results are in line with other research from the Traumatic Stress Studies GroupTraumatic Stress Studies Group. For example, past research shows that multidisciplinary, coordinated responses to different forms of abuse and violence are linked with how providers do their work and case outcomes (e.g., DePrince, Belknap, Labus, Buckingham & Gover, 2012; DePrince, Labus, Belknap, Buckingham & Gover, 2012; DePrince, Wright, Gagnon & Labus, in press; Olomi, DePrince, & Gagnon, in press).
Taken together, the current findings and past research point to the importance of MDTs in responding to violence and abuse. Communities should consider investing in the infrastructure and resources, including time, that allow professionals working from different systems to coordinate child abuse and neglect investigations through a MDT.
This research was supported by the Colorado Evaluation and Action Lab of the University of Denver. The opinions expressed are those of the authors and do not represent the views of the Colorado Lab or the University of Denver. Thank you to our government partners as well as graduate student researchers, especially Maria-Ernestina Christl, Julie Olomi, Adi Rosenthal, and Naomi Wright; research assistants, especially Margaret Port, Francesca Dino, Hannah Branit, Avery Stackle, Madison Hakey, Sandra Dominguez, Veronique Calmels, and Halley Pradell; and Kristin Klopfenstein.
Brink, F. W., Thackeray, J. D., Bridge, J. A., Letson, M. M., & Scribano, P. V. (2015). Child advocacy center multidisciplinary team decision and its association to child protective services outcomes. Child Abuse & Neglect, 46, 174-181.
Since my day-job focuses on trauma and violence, my off-the-clock reading tends towards fantasy and science fiction. I tell people this is my escape, though fantasy and science fiction often reflect back our day-to-day world in stark and profound ways. I was reminded of this recently while reading Jacqueline Carey’s Starless.
Starless opens as you meet Khai, who has been raised as an “honorary boy” in a brotherhood of warriors. At birth, a set of circumstances (read the book) revealed that Khai’s destiny would require him to be a warrior. Raised by the brotherhood, he becomes a skilled fighter by a young age, and a blooded-warrior after killing in battle.
Not until after he becomes a blooded-warrior does Khai learn that he was born a girl and raised a boy. While the length of the novel grapples with what this means to Khai, one particular sentence captivated me. Khai describes:
…I hugged my knees to my chest, unconsciously protecting a body that felt considerably more vulnerable than it had yesterday.”
Khai’s observation reveals much about the gendered nature of vulnerability in our non-fiction world. Vulnerability isn’t inherent to a female body. Rather, it is born of the historical and current reality that violence against girls and women is horribly common. One in four girls are sexually abused in childhood. One in five women are raped in their lifetimes. An average of 137 women are killed each day by family members or partners around the globe. Black trans women are disproportionately likely to be killed. And gender-based violence often goes without accountability for offenders or justice for survivors.
These statistics are brought to life in stories that have been shared for centuries among girls and women, once over clotheslines and today across #metoo posts. Each #metoo is a testament to survival and a reflection of a persistent reality for girls and women: that it could be you too.
What happens if we name this vulnerability? Maybe something like #couldbemetoo.
With a name, we can start to see the long shadow cast by growing up with awareness that it #couldbemetoo, affecting how girls and women organize their lives. From opportunities they do and don’t take to how they navigate homes, schools, and offices.
When women are victimized, they are often blamed for the violence they experienced. The implication is that they were supposed to know the #couldbemetoo risk and plan accordingly to avoid being victimized. They shouldn’t have dated that guy, had that drink, taken that job, gone to that school, worn that outfit, worked at that time of day. The list is wearying and suffocating.
All this got me thinking about questions I sometimes get when I talk about gender-based violence that go something like: Aren’t boys and men victims too? (Spoiler alert: Yes.) Then, why talk about gender-based violence? What’s gender got to do with it anyway?
Boys and men are victims of violence – and all intimate violence, regardless of the survivors’ gender, is preventable and unnecessary. Focusing on girls and women is not a negation or effort to ignore boys’ and men’s experiences. Rather, it’s a recognition that girls and women are disproportionately victimized by intimate partners. And that there are dynamics — due to the gendered nature of intimate abuse and the gendered nature of the world in which we live — that warrant attention.
Naming gender helps us recognize the vulnerability of living life knowing it #couldbemetoo, borne primarily by girls and women.
In fact, our country communicates every single day to girls and women that #couldbemetoo is a routine part of life and a burden they must shoulder. We communicate this each time that under-resourced communities can’t offer prevention programming. Or waitlists drag on for crisis services and interventions. Or offenders are not held accountable. Or Congress fails to re-authorize the Violence against Women Act (VAWA).
The effect of our collective action (and inaction) is captured so poignantly in that moment when Khai expresses that to be a girl is to be vulnerable to assault, no matter how strong and well trained you are. Even if you’re a warrior.
In tolerating gendered violence, we let the shadow of knowing it #couldbemetoo stretch into the future, dimming the potential of a new generation of girls. We have to do better.
Of course, re-imagining and re-creating a world that is intolerant of violence against girls and women is daunting. Don’t worry, though – Khai has plenty to teach us about working together to change the world. So go ahead, read the book. And take some notes because tomorrow we have to get up and start building a new world where girls get to grow up expecting to be safe in their bodies.
Acknowledgements: Starless by Jacqueline Carey was published in 2018 by Tor Books; quote p. 127. Thank you to Naomi Wright, Susan Buckingham, Julie Olomi, and Lindsey Feitz for comments on an earlier draft.
Blows to the head are common among women experiencing intimate partner abuse (IPA), as documented in recent research nationally (e.g., Corrigan, Wolfe, Mysiw, Jackson, & Bogner, 2003; Wilbur et al., 2001) and from the Traumatic Stress Studies Group (Gagnon & DePrince, 2017). Despite prevalence data, traumatic brain injury (TBI) and IPA have received scant policy and research attention. For example, the Centers for Disease Control and Prevention’s 2015 report to Congress, Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation, failed to even mention IPA.
Victim service providers, recognizing the occurrence of TBIs among clients, have begun to integrate traumatic brain injury (TBI) screenings into practice. Unfortunately, the lack of research on TBI and IPA means that there is not yet an adequate empirical base to inform practices for the use of TBI screenings in decision-making and treatment-planning for women experiencing IPA.
We plan to address these gaps in a new study.
With funding from MINDSOURCE Brain Injury Network (Colorado Department of Human Services), the Traumatic Stress Studies Group will collaborate with Drs. Julia Dmitrieva (Department of Psychology, University of Denver), Kim Gorgens (Graduate School of Professional Psychology, University of Denver) and the Rose Andom Center to answer key questions about TBI and IPA.
In particular, we have designed a study that promises to result in an empirically-informed approach to screening for TBI among women experiencing IPA. By partnering with the Rose Andom Center — a multidisciplinary facility that serves women who have experienced IPA — we will ensure that the research conducted is relevant to providers and ready for their use. We also hope that this research will advance understanding and awareness of links between IPA and TBI in Colorado — and nationally.
Stay tuned for more on this new study as we begin data collection later this year.
With the widely-reported sex crimes charges against Jeffrey Epstein, people are talking about sex trafficking and expressing outrage. We need to harness those conversations and that energy to work towards ensuring that our communities are prepared to respond to the trauma-related needs of sex trafficking survivors.
Here are a few lessons from a study involving in-depth interviews with eleven women who survived sex trafficking, which can be harnessed by communities to support sex trafficking victims and survivors:
Recognize the far-reaching consequences of trafficking as a betrayal trauma. Among the women interviewed, the most frequent trafficker was a family member or intimate partner, highlighting the role that betrayal by someone close plays in sex trafficking. Women commonly reported feelings of shame and alienation in relation to the trafficking. Thus, getting away from the trafficker may mean escaping abuse and losing a family member or partner at a time when women are alienated from other supports.
Traumas that involve betrayal can have far-reaching health and social-relationship consequences (e.g., Gagnon, Lee, & DePrince, 2017). Post-traumatic feelings such as shame and alienation are linked with psychological distress (e.g., DePrince, Chu & Pineda, 2011). Thus, supporting women as they heal from the consequences of betrayal trauma, including as they build new social support systems, may be particularly important. Social support plays a critical role in coping with traumatic stress (e.g., Schnurr, Lunney, & Sengupta, 2004; Brewin et al., 2000; Ozer et al., 2003).
Recognize the cumulative impact of traumas beyond sex trafficking. The women interviewed described having experienced many forms of trauma, such as experiences of forced sex, witnessing other people being seriously injured or killed, robberies, and physical abuse. Cumulative trauma exposure is linked with more severe traumatic stress symptoms (e.g., Martin et al., 2013)
Build referral networks that facilitate connecting women with services to meet complex psychological and physical health needs, regardless of the services that agencies themselves provide. Trafficking survivors interviewed in this pilot study reported high levels of posttraumatic stress disorder (PTSD) and depression symptoms. When asked about sixty different kinds of physical health symptoms, women reported experiencing an average of more than 18 different symptoms over the last year alone. Women’s health can affect their ability to engage with services and providers, even for things that seem unrelated to health, such as legal services.
Design communications to anticipate potential attention and memory problems. Nearly all of the women interviewed reported being struck in the head in their lifetimes, including multiple blows to the head resulting from violence. All of the women who had been struck in the head reported losing consciousness and/or being dazed/confused as a result. Head injuries as well as posttraumatic symptoms (e.g., PTSD, depression) can affect attention and memory. As a result, being clear in communications with survivors may be especially important as well as taking opportunities to repeat information over time. For more on such recommendations, check out a recent article on attention and domestic violence from our team (Lee & DePrince, 2017).
Leverage interactions to validate and support survivors. Women in this pilot study echoed what we have learned from survivors of other forms of intimate violence about interactions with service providers. For example, women in this sample described things that law enforcement officers did that were validating, such as:
- Letting survivors talk
- Believing survivors
- Asking survivors what they need
- Letting survivors know about resources
- Saying things such as: “It takes courage to come forward”
- Helping survivors feel protected and safe
- Providing clear explanations of what to expect
Communities have a role to play in ensuring services are available and responsive to sex trafficking survivors’ trauma-related needs. Trauma-informed responses should take into account the potentially far-reaching psychological, physical health, and social-relationship consequences of sex trafficking. Agencies and providers can play an important role in conveying support for survivors and connecting them with resources.