© 2008 Springer Publishing Company 221
Violence and Victims, Volume 23, Number 2, 2008
Child Abuse in the Context of
Domestic Violence: Prevalence,
Explanations, and Practice
Ernest N. Jouriles, PhD
Renee McDonald , PhD
Southern Methodist University
Amy M. Smith Slep, PhD
Richard E. Heyman , PhD
State University of New York, Stony Brook
Edward Garrido , PhD
Southern Methodist University, Dallas, Texas
This article addresses the following questions: (a) How common is child abuse among
domestically violent families? (b) Are there specific patterns of child abuse among domes-
tically violent families? (c) What may explain occurrences of child abuse in domestically
violent families? (d) How might domestic violence affect treatment for child abuse? We
review research on child abuse in the context of domestic violence. We discuss implica-
tions of this research for service-delivery programs for domestically violent families.
K e y w o r d s : child abuse; domestic violence; prevalence; co-occurrence
omestic violence (defined here as violence against a current or former intimate
partner with whom the abuser shares or has shared a domicile) is now recog-
nized by many as a worldwide problem that dramatically affects the health and
well-being of those exposed to it. Although women may be the most obvious victims of
domestic violence, their children are victims as well. For example, children exposed to
domestic violence are at risk for a variety of adjustment difficulties. These include aggres-
sive and oppositional behavior, anxiety and depressive symptoms, social problems and
cognitive difficulties (see Jouriles, Norwood, McDonald, & Peters, 2001; Wolfe, Crooks,
Lee, McIntyre-Smith, & Jaffe, 2003, for reviews). In addition, children living in families
characterized by domestic violence are at increased risk for physical abuse and other forms
of child maltreatment (Appel & Holden, 1998; Edleson, 1999). The adjustment difficulties
of physically abused children are similar to those of children exposed to domestic violence
(Kolko, 2002), and there is some evidence that the problems experienced by children
in domestically violent families are due, in part, to co-occurring child abuse (Jouriles,
222 Jouriles et al.
Barling, & O’Leary, 1987; Mahoney, Donnelly, Boxer, & Lewis, 2003). Unfortunately,
despite widespread acknowledgment of child abuse in many domestically violent families,
there has been surprisingly little application of this knowledge in service-delivery pro-
grams targeting such families.
T h i s a r t i c l e r e v i e w s t h e s c i e n t i f i c l i t e r a t u r e o n c h i l d a b u s e t h a t o c c u r s w i t h i n f a m i l i e s i d e n -
tified as domestically violent. We attempt to provide science-informed answers to important
practical questions: How common is child abuse among domestically violent families? Are
specific patterns of co-occurrence (that is, are mothers, fathers, or both parents abusive toward
their children within domestically violent homes) most likely? What may explain occurrences
of child abuse in domestically violent families? How might domestic violence affect treatment
for child abuse? Based on the scientific literature, we offer suggestions for consideration in the
assessment and treatment of families seeking services for domestic violence.
At the outset, it is important to acknowledge that the term “child abuse” is broad,
encompassing a wide range of acts and omissions. For example, professional organiza-
tions, policymakers, researchers, clinicians, law enforcement personnel, and child welfare
agencies refer to specific categories or types of child maltreatment (e.g., physical abuse,
psychological or emotional maltreatment, neglect, and sexual abuse). Moreover, these
categories often are further divided into subcategories; neglect, for example, is com-
monly defined more specifically as physical, medical, or educational neglect. Although
this illustrates the conceptual breadth of child maltreatment, most research on child abuse
within domestically violent families focuses specifically on physical child abuse, com-
monly defined by acts such as “hitting with a hand, stick, strap, or other object; punching;
kicking; shaking; throwing; burning; stabbing; or choking” (Sedlak & Broadhurst, 1996,
pp. 2–10) that harm or significantly endanger a child. Thus, in summarizing the research
literature on child abuse in domestically violent families, we restrict our use of the term
“child abuse” to physical child abuse.
It also is important to acknowledge that there is debate about whether children witness-
ing domestic violence should itself be considered a form of child maltreatment. Exposing
children to domestic violence, especially to frequent or severe domestic violence, has been
conceptualized by some as a form of child psychological/emotional maltreatment (e.g.,
Graham-Bermann, 1998; Sedlak & Broadhurst, 1996), and it has been defined as a crime
in certain states (see Graham-Bermann, 2002, for specific examples). As indicated earlier,
children in families characterized by domestic violence are at increased risk for adjustment
difficulties (Jouriles et al., 2001; Wolfe et al., 2003), and it is difficult to imagine how
repeated exposure to domestic violence could be benign. On the other hand, many com-
mon parent behaviors are known to have deleterious consequences for children (e.g., alco-
hol abuse, smoking), and it is difficult to discern where the line should be drawn between
what is irresponsible, inappropriate, or just “bad for children” and what is abusive. The
admittedly narrow focus in this article on physical child abuse sidesteps the thorny philo-
sophical, moral, and legal issues about what constitutes “abuse.” However, it renders the
scope of discussion in this article manageable.
HOW COMMON IS CHILD ABUSE AMONG
DOMESTICALLY VIOLENT FAMILIES?
Definitions of child abuse, methods for collecting data on parental aggression toward chil-
dren, and conceptualizations of co-occurrence are key factors that complicate answering
Child Abuse in the Context of Domestic Violence 223
the question: How common is child abuse among domestically violent families? We do
not provide an exhaustive review and discussion of these complicating factors; rather, we
offer examples that illustrate the issues and structure the following review of the scientific
Definitions and Methods
P h y s i c a l c h i l d a b u s e i s o f t e n d e f i n e d d i f f e r e n t l y a c r o s s s t u d i e s . A s m i g h t b e e x p e c t e d ,
broad definitions of physical child abuse (e.g., those that include pushes, slaps, and spank-
ings) yield relatively high prevalence rates, whereas narrow definitions yield lower rates
(O’Keefe, 1995; Slep & O’Leary, 2005). In this review, we address the question, “How
common is child abuse among domestically violent families?” separately for studies that
use broader and narrower definitions of physical child abuse.
Methods for assessing parental aggression toward children or child abuse (e.g., mea-
sures, sources of data) also influence prevalence estimates, with child and parent reports
during interviews or on questionnaire measures typically yielding higher rates of aggres-
sion/abuse than official records (Kolko, 2002). Also, family members themselves often
provide discrepant reports of parental physical aggression toward children (Jouriles,
Mehta, McDonald, & Francis, 1997). Thus, prevalence rates are likely to be higher if one
considers multiple family members’ reports rather than the report of any single family
member. Consequently, in addressing the prevalence question, we highlight the methods
used by investigators to make child abuse determinations.
The reference period, or the time frame for which abuse is assessed, ranges greatly
across studies. For example, some investigators have considered “childhood” as the refer-
ence period. That is, adult participants are asked to report retrospectively on whether they
witnessed domestic violence or experienced child abuse at some point during their child-
hood; a report of both forms of violence by an individual is conceptualized to indicate co-
occurring domestic violence and child abuse. More commonly, though, adult participants
are asked whether they have engaged in specific behaviors indicative of domestic violence
and child abuse during a shorter, more recent time period (e.g., within the past year). In
the present review, we focus on families marked by domestic violence and physical child
abuse that occurred within the year prior to the assessment.
Conceptualizations of Co-Occurrence
Co-occurrence can be conceptualized as a within-individual phenomenon (e.g., a husband
abuses his wife as well as his children), one that occurs across individuals within the same
family (e.g., a husband abuses his wife and the wife abuses her children), or both (e.g., a
husband abuses his wife and both the husband and wife abuse the children). In this review,
we consider both within- and across-individual co-occurrence of domestic violence and
child abuse, and we clearly articulate the perpetrator of the child abuse when these data
We used a variety of methods to search for empirical articles that present an estimate of the
prevalence of child abuse within domestically violent families or allowed us to derive such
an estimate . We began with the studies summarized in Appel and Holden’s (1998) review
of this topic. To add to their list, we conducted keyword searches for articles published
224 Jouriles et al.
since 1998. Articles from the following electronic databases were included: PsycINFO,
MEDLINE, the Psychology and Behavioral Sciences Collection, and the Sociological
Collection. Keywords used in the search included child abuse, domestic violence, violence,
family violence, co-occurrence, and prevalence. We also conducted keyword and author
searches more generally, using Google, the MINCAVA (the University of Minnesota
School of Social Work electronic clearinghouse) Web site, the U.S. Department of Health
and Human Services Web site, and University of New Hampshire Family Research
Laboratory Web site. We reviewed reference sections of the collected articles to identify
additional articles. We also conducted a review of literature on child witnesses of domestic
violence because rates of child abuse are sometimes reported in these articles.
T o a d d r e s s t h e q u e s t i o n — How Common Is Child Abuse in the Context of Domestic
Violence? — w e f o c u s e d o n s t u d i e s i n w h i c h i t w a s p o s s i b l e t o d i s c e r n t h e n u m b e r o f
families in which domestic violence had occurred and, within those families, the num-
ber in which physical child abuse had occurred. We also focused on studies in which
child abuse was unambiguously defined (e.g., specific acts were listed as part of the
definition) and was measured within a 1-year time frame of the domestic violence. We
excluded studies in which the primary sample was identified on the basis of child abuse
rather than domestic violence because such studies address the different but related
question of domestic violence in the context of child abuse rather than the topic of
this review, child abuse in the context of domestic violence. Tables 1 and 2 summarize
Table 1 is limited to those in which a more restricted definition of physical child abuse
(often referred to as severe parental aggression) is used. Although there is still variability
in the definitions across these studies, most defined child abuse as a variant of the follow-
ing: “ hit him or her on some other part of the body besides the bottom with a hard object;
threw or knocked down; hit him or her with a fist or kicked hard; beat up, that is hit him
or her over and over as hard as parent could; grabbed around the neck and choked; and
threatened with a knife or gun ” (Mahoney et al., 2003, p. 7). Studies in which spankings,
slaps, and pushes are part of the definition of child abuse are excluded from Table 1. Table 2
includes studies with a broader, more inclusive definition (e.g., any parental physical
aggression toward children including spankings, slaps, and pushes); however, aside from
the definition, Table 2 studies are similar to those in Table 1.
Studies in Table 1 are listed in descending order of the prevalence of physical child
abuse in the context of domestic violence. Perhaps the most striking feature of Table 1 is
the broad range of estimates of physical child abuse in domestically violent families—18%
to 67%. Reasons for this breadth are not immediately apparent, but characteristics of the
studies themselves, in particular the samples employed, reveal several possible explana-
tions. First, a close inspection of Table 1 suggests that child abuse may be less prevalent
in domestically violent families identified in community surveys as opposed to domesti-
cally violent families in which women are seeking refuge from violence at a shelter or
the family is seeking other clinical services. This is an important observation, particularly
for clinicians working with domestically violent families. It also seems important for
understanding what differences may exist between help-seeking and non-help-seeking
families that help explain the variability in the estimates in Table 1. For example, it is
now well-documented that the frequency and form of domestic violence in shelter-seeking
families is drastically different than that in “violent” community families identified in sur-
vey research (Johnson, 1995). Thus, to the extent that frequency and severity of domestic
violence relates positively to risk for child abuse (and it does; see discussion below), one
TABLE 1. Child Abuse in the Context of Domestic Violence: Severe Definitions of Child Abuse, 1-Year Time Frame
Child Age Sample
Assessment Co-Occurrence Rate
Mahoney, Donnelly, Boxer, & Lewis (2003) 78 families 11–18 Youth community
MR and CR 67% P
O’Keefe (1995) 120 women
7–13 DV shelter MR 67% P
Giles-Sims (1985) 27 women <18 DV shelter MR 56% W
Straus, Gelles, & Steinmetz (1980) 176 families 3–17 Community MR or PR 43% P
McCloskey (2001) 193 families 6–12 DV shelter and
MR and CR 42% M
Jouriles, Spiller, Stephens, McDonald, &
154 families 8–12 DV shelter MR and CR 31% P
Straus & Gelles (1988) 483 families <18 Community MR or PR 31% P
Slep & O’Leary (2005) 107
couples 3–7 Community MR and PR 22% P
Note. MR = Mother Reports; PR = Partner Reports; CR = Child Reports; P = Abuse by either parent; W = Abuse by women; M = Abuse by men.
Indicates the number of participants with children who also reported any domestic violence.
These rates are based on the most frequently
reported abusive act, “hit with an object.”
This is the number of couples who reported severe interpartner violence.
TABLE 2. Child Abuse in the Context of Domestic Violence: More Liberal Definitions of Child Abuse, 1-Year Time Frame
Child Age Sample
Assessment Co-Occurrence Rate
Kolbo (1996) 60 families 8–11 Families seeking services MR or PR 97% P
Slep & O’Leary (2005) 220 couples 3–7 Community MR and PR 94% P
Holden, Stein, Ritchie, Harris, & Jouriles
(1998) Study I
37 women 2–8 DV shelter MR 92% W
Giles-Sims (1985) 27 women <18 DV shelter MR 93% W
Jouriles, Barling, & O’Leary (1987) 45 families 5–13 Families seeking services MR 91% P
Holden, Stein, Ritchie, Harris, & Jouriles
(1998) Study II
30 women 3–7 DV shelter MR 90% W
McCloskey (2001) 193 families 6–12 DV shelter and community MR and CR 83% M
Jouriles & Norwood (1995) 48 women
4–14 DV shelter MR and CR 81% boys P
69% girls P
85% boys P
60% girls P
Holden, Stein, Ritchie, Harris, & Jouriles
(1998) Study III
32 women 4–9 DV shelter MR 75% W
Kruttschnitt & Dornfeld (1992) 50 families 11–12 DV shelter MR and CR 74% W
Saltzman, Holden, & Holahan (2005) 21 families 5–13 DV victims seeking services MR 48% P
Moore & Pepler (1998) 73 women 6–12 DV shelter MR 40% P
Note. MR = Mother Reports; PR = Partner Reports; CR = Child Reports; P = Abuse by either parent; W = Abuse by women; M = Abuse by men.
Indicates the number of participants with children who also reported domestic violence.
Child Abuse in the Context of Domestic Violence 227
might expect higher rates of child abuse in samples characterized by frequent and severe
domestic violence (such as shelter-seeking families).
It is possible that variability in definitions of child abuse also accounts for variability
in child abuse rates across studies in Table 1. For example, in the O’Keefe (1995) study,
child abuse was defined by the occurrence of one of the following acts directed against
the child in the year prior to the assessment: hitting with an object (e.g., a belt or paddle),
kicking, biting, punching, burning, beating up, choking, and attacking with a gun or knife.
However, many people object to “hitting with an object” as an indicator of abuse. When
O’Keefe recalculated child abuse rates without this item, 35% of the children were consid-
ered abused (as opposed to the 67% reported in Table 1). In addition to the O’Keefe study,
four other studies in Table 1 (Giles-Sims, 1985; Mahoney et al., 2003; Straus & Gelles,
1988; Straus, Gelles, & Steinmetz, 1980) included “hitting with an object” or “hit or tried
to hit with something” as part of their definition of child abuse. Slep and O’Leary (2005)
included a variant of this item: “hit some other part of the body other than the bottom with
something like a belt, hairbrush, a stick or some other hard object.” McCloskey (2001) and
Jouriles, Spiller, Stephens, McDonald, and Swank (2000) did not include such an item as
part of their definition.
Also related to the point about differences in help-seeking and non-help-seeking fami-
lies, we inspected demographic characteristics of the participants in the studies listed in
Table 1. There was variability across studies in family income; for example, Jouriles et al.
(2000) reported a median annual family income of $15,980, whereas Slep and O’Leary
(2005) reported a median annual family income of $74,500. There was also variability
across samples in ethnic and racial diversity. However, it is not clear if these demo-
graphic characteristics related to rates of child abuse within domestically violent families
(across studies). For example, the two studies reporting the highest rates of parental child
abuse (67%; Mahoney et al., 2003; O’Keefe, 1995) consisted of very different samples.
Specifically, in the Mahoney et al. study, the sample was 90% White and the modal fam-
ily income was in the $36,000–$60,000 range. In the O’Keefe study, the sample was 42%
White and the modal family came from “low socioeconomic backgrounds.” In short,
while it is impossible to make systematic comparisons across the studies listed in Table 1
on sample demographic characteristics, it does not appear that racial/ethnic diversity or
income level account for a large portion of the variability of the estimates of child abuse
within these studies.
Table 2 illustrates how rates of child abuse are higher when more inclusive defini-
tions of child abuse are applied. In each of these studies, slaps and spanks were part of
the definition of physical child abuse. There, again, is a range in estimates of the rate of
parental child abuse (40% to 97%). However, the rates are all very high, with most studies
exceeding 75%. It is also important to notice, in both Tables 1 and 2, that when data were
reported in a manner so that the perpetrator of the child abuse could be identified, rates of
child abuse are approximately equal for mothers and fathers.
In addition to the information in the tables, several other findings are worth highlight-
ing. First, a number of investigators have directly compared rates of child abuse across
domestically violent and nonviolent families. Although the majority found higher rates
of child abuse (almost twice as high or higher) within domestically violent families
(Mahoney et al., 2003; Ross, 1996; Rumm, Cummings, Krauss, Bell, & Rivera, 2000; Slep
& O’Leary, 2005; Straus et al., 1980), there were also studies that found no differences
(Eckenrode et al., 2000; McDonald, Jouriles, Norwood, Ware, & Ezell, 2000). Second,
when domestic violence is more frequent, parental aggression toward children is also more
228 Jouriles et al.
frequent (Jouriles et al., 1987; Jouriles & LeCompte, 1991; Ross, 1996). That is, there is
a positive correlation between the frequency of domestic violence and parental aggression
toward children. Third, there is some evidence that boys in domestically violent families
are at a higher risk for parental aggression than girls (Jouriles & Lecompte, 1991; Jouriles
& Norwood, 1995; Ross, 1996; Straus et al., 1980).
ARE SPECIFIC PATTERNS OF CO-OCCURRENCE MOST LIKELY?
In their review of the literature on co-occurring domestic violence and child abuse,
Appel and Holden (1998) proposed different patterns of co-occurrence, four of which are
depicted in Figure 1. These patterns are descriptive, indicating who is abusing whom. We
are aware of only two studies designed to compare the relative prevalence of these different
patterns of co-occurrence (Mahoney et al., 2003; Slep & O’Leary, 2005). In both studies,
only a small percentage of the co-occurrence cases fit the sole perpetrator model in which
one parent directs physical aggression toward the partner and the child (<18%). Similarly,
only a small proportion fit the sequential perpetrator model in which one parent engages
in domestic violence while the other parent targets the child (<18%). The dual perpetrator
model fit 21.2% of the families in the Mahoney et al. (2003) study but none of the fami-
lies in the Slep and O’Leary study. The marital violence model was the most common by
far in both studies characterizing over 50% of the domestically violent families in which
child abuse also occurred. That is, it appears most common for both spouses to engage in
Figure 1. Models of child abuse perpetration in domestically violent families.
Child Abuse in the Context of Domestic Violence 229
domestic violence and for one or both to use severe aggression toward the child. It is also
useful to note that in the marital violence model, mothers were about as likely as fathers to
use severe physical aggression toward the child. Although the patterns were similar across
studies, caution is encouraged in interpreting these results; there are only two studies, and
each included a small number of domestically violent families.
WHAT MAY EXPLAIN OCCURRENCES OF CHILD ABUSE
IN DOMESTICALLY VIOLENT FAMILIES?
Several plausible hypotheses have been offered to explain why child abuse is so prevalent
within domestically violent families. One explanation is that certain individuals have a
propensity for aggressive behavior, and because of this propensity anyone who spends
time with these individuals (partners and children) is at increased risk for becoming a vic-
tim of violence (McCloskey, 2001). This “aggressive individual” explanation, of course,
applies to co-occurring domestic violence and child abuse perpetrated by the same indi-
vidual. This explanation is rooted in general theories of crime and deviance (e.g., Donovan
& Jessor, 1985; Gottfredson & Hirschi, 1990), which suggest that aggressive individuals
do not tend to specialize in particular forms of aggression (domestic violence vs. child
abuse). Rather, they simply tend to be aggressive and do not differentiate among targets.
This explanation typically invokes person-based variables to explain why these individuals
have a propensity for aggressive behavior. Examples of such variables include personality
characteristics (e.g., impulsivity, hostility), biological characteristics (e.g., physiological
reactivity to stress), psychological functioning (e.g., depression, substance dependence),
and historical risk factors that set the stage for later aggression (e.g., exposure to violence
in family of origin). Consistent with this hypothesis, many of the person-based variables
that explain why individuals have a propensity for aggressive behavior are correlates of
both domestic violence and child abuse (Slep & O’Leary, 2001), and certain person-based
variables (e.g., depression, substance dependence) have been found to be at higher levels
in families marked by both wife abuse and child abuse, compared to families marked by
only one of these forms of abuse (e.g., O’Keefe, 1995; Tajima, 2004).
A n a l t e r n a t i v e e x p l a n a t i o n i s t h a t a g g r e s s i v e b e h a v i o r , i n c l u d i n g b o t h p a r t n e r a n d c h i l d
abuse, is triggered by stressful events or a series of events or circumstances that cause stress.
Patterson (1982), for example, hypothesized that the accumulation of family crises and stress-
ful circumstances leads to higher levels of negativity/aggression across family dyads (parent–
child, parent–parent), particularly among family members for whom interpersonal aggression
had been reinforced in the past. Consistent with this hypothesis, indicators of stress, such
as economic and parenting stress, are correlates of both domestic violence and child abuse
(Slep & O’Leary, 2001). In addition, certain types of family stressors (e.g., financial stress,
parenting stress, child behavior problems) appear to potentiate the relation between domestic
violence and child abuse (Jouriles & Norwood, 1995; Margolin & Gordis, 2003).
Another possible explanation is that one type of abuse either causes or sets the stage
for the other. This explanation is most often presented as a variant of the spillover hypoth-
esis, wherein domestic violence, most often defined as husband-to-wife aggression, spills
over and increases the likelihood of parental violence, usually defined as mother-to-child
aggression. Several conceptualizations of this hypothesis have been offered in the literature.
One suggests that the negative affect and arousal generated by husband-to-wife violence
spills over into parent–child interaction, increasing the likelihood of parental attacks on the
230 Jouriles et al.
children (Margolin & Gordis, 2003). Another conceptualization is that domestic violence
prompts mothers to purposefully direct aggression toward their children (for misbehaving)
in an effort to avoid angering their violent husbands (e.g., a mother becomes overbearing
to keep her children quiet; McKay, 1994). That is, the aggression toward the children
might actually be intended to protect them and/or the mother from a more severe attack by
the husband (Margolin & Gordis, 2003).
It is quite possible, even probable, that the processes hypothesized above operate simul-
taneously. That is, child abuse in domestically violent families is not likely to be explained
by any single process. Despite considerable speculation about what explains the increased
prevalence of child abuse in domestically violent families, we are still far from making
strong, empirically supportable conclusions.
HOW MIGHT DOMESTIC VIOLENCE AFFECT
TREATMENT FOR CHILD ABUSE?
A l t h o u g h t h e r e a r e a n u m b e r o f s t u d i e s o n c h i l d a b u s e p r e v e n t i o n a n d t h e t r e a t m e n t o f a b u s -
ing parents, very little is available on the treatment/prevention of child abuse in the context
of domestic violence. A notable exception is the work of Eckenrode, Olds, and colleagues
on their home visitation program. Specifically, certain home visitation interventions have
been found to reduce the likelihood of child maltreatment. These interventions typically
involve regular visits by a professional (e.g., nurse) to a family’s home over a period of
months/years. Home visitors typically strive to form a positive relationship with family
members (supporting their strengths), teach parents about child development, facilitate
appropriate and stimulating parent–child interaction, and promote positive family health.
I n a s e c o n d a r y a n a l y s i s o f d a t a f r o m a w e l l - k n o w n r a n d o m i z e d t r i a l t a r g e t i n g f a m i l i e s a t
risk for child maltreatment (details of the intervention and the study sample can be found in
Olds et al., 1997; Olds, Henderson, Chamberlin, & Tatelbaum, 1986), the investigators found
that the likelihood of child maltreatment was reduced for families receiving the home visita-
tion program. Impressively, this reduction occurred over a 15-year, postintervention follow-
up period. However, for families with more than 28 incidents of domestic violence over the
15-year follow-up period, the home visitation program did not reduce the likelihood of child
maltreatment (Eckenrode et al., 2000). Although it is not clear precisely why this particular
intervention was less effective for domestically violent families, Eckenrode and colleagues
speculated that domestic violence is associated with compromised parenting, an interpreta-
tion consistent with the spillover hypothesis as well as with research on the link between
domestic violence and parenting (e.g., Levendosky & Graham-Bermann, 2001). In short,
this particular finding cautions against simply presuming that empirically supported child
maltreatment programs work equally well for domestically violent and nonviolent families.
A second exception is the work of Jouriles, McDonald, and colleagues (Jouriles &
McDonald et al., 2001; McDonald, Jouriles, & Skopp, 2006). These investigators devel-
oped and evaluated Project SUPPORT, an intervention designed for families departing
from women’s shelters with at least one child exhibiting clinical levels of conduct prob-
lems. Although the goal of the intervention was to reduce conduct problems among the
children, a key method for accomplishing this was to reduce parent–child aggression. The
intervention included two core components: (a) providing instrumental and emotional
support to mothers after shelter departure, and (b) teaching mothers to implement a set
of child management and nurturing skills. Services were initiated shortly after shelter
Child Abuse in the Context of Domestic Violence 231
departure, were home-based, and lasted up to 8 months. The results of the initial evaluation
of Project SUPPORT were quite promising (Jouriles & McDonald et al., 2001 ; McDonald
et al., 2006). Eight months after completion of treatment (16 months after the families had
departed the shelter), results indicated that mothers learned to properly apply child man-
agement techniques more rapidly in the Project SUPPORT intervention condition than in
the existing services comparison condition. In addition, in a follow-up conducted 2 years
after treatment, mothers in the Project SUPPORT condition were less likely than mothers
in the comparison condition to use aggressive child management strategies.
In sum, the secondary analysis of Olds’s home visitation program indicates that domes-
tic violence may limit the effectiveness of some interventions that are otherwise effective
in preventing child abuse; however, the evaluation of Project SUPPORT suggests that child
abuse can be addressed in the context of domestic violence. There are many differences
between these two evaluation projects, making it impossible to pinpoint the reasons for
these different findings. For example, Olds’s home visitation program was designed for
mothers of infants and very young children who were at risk for child maltreatment (but
not necessarily at risk because of domestic violence), and the intervention began prior
to the birth of the child. Project SUPPORT was designed for mothers and children who
sought refuge at a shelter for domestic violence, and it targeted families of preschool and
elementary school-aged children exhibiting clinical levels of conduct problems. Both pro-
grams averaged between 20 and 35 home visits, but Olds’s home visitation services were
spread out over 2.5 years, whereas the Project SUPPORT services were condensed into an
8-month period. It seems reasonable to conclude, though, that domestic violence may be a
context that requires focused and intensive services for child abuse.
CLINICAL IMPLICATIONS FOR THE ASSESSMENT
OF CHILD ABUSE
The research reviewed above suggests that child abuse is prevalent within domestically
violent families. In fact, a case could be made that, more often than not, there has been
an incident of severe caregiver aggression directed toward a child (within a year of the
domestic violence) in service/refuge-seeking domestically violent families. Although
the research is sparse, it appears that the most typical pattern of co-occurring domestic
violence and child abuse is that both parents aggress against each other, and one or both
aggress against the child. This points to the need to assess for parental aggression toward
children (perpetrated by both men and women) when domestic violence is identified, par-
ticularly from the perspective of protecting at-risk children. This suggestion for assessment
should not be confused with investigating for child abuse; however, from the perspective
of protecting at-risk children, questions about parental aggression toward children should
be asked and appropriate referrals should be made when indicated.
For clinicians, though, the decision to assess for parental aggression toward children in
a domestically violent family raises a number of ethical, legal, and clinical considerations.
The possibility of uncovering abuse that necessitates a report to Children’s Protective
Services (CPS) may prompt concerns about subjecting a domestic violence victim or an
offender newly engaged in treatment to an investigation typically perceived by parents
as intrusive rather than helpful (Bragg, 2003). In addition, reports to CPS about families
who are already receiving clinical services often do not lead to service recommendations
that differ from those in which the family is already engaged. Clinicians are also likely to
232 Jouriles et al.
have concerns about damaging the therapeutic alliance, increasing the family’s resistance
to treatment and the risk for dropout, and subjecting domestic violence victims to addi-
tional coercion by failing to respect their autonomy in making important family decisions
(Beeman, Hagemeister, & Edleson, 1999; Lewis, 2003).
C l i n i c i a n s m u s t a l s o b e s e n s i t i v e t o p r a c t i c a l r e a l i t i e s w h e n c o n f r o n t i n g d o m e s t i c a l l y
violent families. Victims of domestic violence may have real (and realistic) fears about their
children being taken away either by an agency (e.g., CPS, for failure to protect) or by their
partners. Such fears are sometimes encouraged and even exacerbated by domestically violent
partners who threaten to “take” or abduct the children or see that the victim loses custody of
the children. Family members may also be reasonably fearful about their own physical safety
if they disclose child abuse. Assessments may prompt questions among family members
(“What did you tell them about. . . . ?”), which may lead to additional incidents of abuse.
Financial concerns also govern disclosures of child abuse. For example, the fear of unwanted
family separation that may engender financial hardships for the family, such as the father’s
removal from the home or arrest and detention, likely reduces disclosure of child abuse.
B e f o r e a s s e s s i n g f o r p a r e n t a l a g g r e s s i o n t o w a r d c h i l d r e n , i t i s i m p o r t a n t t o c o n s i d e r a
number of details. These include the timing of assessments (e.g., toward the end of an initial
assessment session), measures to be used (see Friedrich, Olafson, & Connelly, 2004; Milner,
1995, for descriptions of measures), how the assessments are to be conducted (e.g., individual
interviews with family members), the frequency in which such assessments will be conducted
over time, and safety planning for family members. It is also important to consider how the
definition of abuse used during the assessment may differ from definitions used in mandated
reporting laws. Such differences are important to recognize, and knowledge about such dif-
ferences will minimize confusion and ensure adherence to the law when potentially report-
able maltreatment is detected. Families should be informed of the limits of confidentiality,
including legal requirements to report suspicions of child abuse, during the informed consent
p r o c e s s . I n a d d i t i o n , t h e c l i n i c a l r e l e v a n c e a n d i m p o r t a n c e o f s u c h a s s e s s m e n t s s h o u l d b e
made explicit to families. Gathering information about parental aggression toward children
without a client-focused, clear, and cogent rationale is likely to be met with resistance.
CLINICAL IMPLICATIONS FOR THE TREATMENT
OF CHILD ABUSE
E v i d e n c e i s s p a r s e , l i m i t e d i n s c o p e , a n d m i x e d o n t h e e f f i c a c y o f t r e a t m e n t o r p r e v e n t i o n
efforts for child abuse in the context of domestic violence. In theory, treatment for child
abuse might be more effective following treatment for domestic violence, especially given
certain hypotheses for what explains the increased prevalence of child abuse in domestically
violent families (e.g., spillover hypothesis). However, given the very limited effectiveness
of most domestic violence interventions (see meta-analysis by Babcock, Green, & Robie,
2004) and the immediate risks potentially faced by children in these families, it is, of
course, not appropriate to simply wait for the domestic violence to stop before beginning
an intervention to protect children from maltreatment. We acknowledge clear answers about
how to proceed on this topic are unavailable, but we offer several suggestions.
F i r s t , a s n o t e d a b o v e , i t s e e m s r e a s o n a b l e t o c o n c l u d e t h a t d o m e s t i c v i o l e n c e m a y i n t e r f e r e
with child abuse prevention/intervention efforts, but it does not make child abuse impossible
to address. Although there is not a body of research explicitly evaluating treatment for child
abuse in domestically violent families, characteristics of programs deemed effective in
Child Abuse in the Context of Domestic Violence 233
related treatment research (e.g., Jouriles & McDonald et al., 2001) suggest that providing
home-based intervention services and providing mothers who are victims of domestic vio-
lence with comprehensive training in child nurturing and child management skills can reduce
risk for child abuse in domestically violent families. Such programs might be used as a point
of departure for efforts to treat child abuse within the context of domestic violence.
Second, as reviewed earlier, several person-based and environmental variables have been
identified as risk factors for both domestic violence and child abuse. Accordingly, treatment
strategies targeting those risk factors may help reduce the risk for both child abuse and domestic
violence. For example, depression or substance abuse (risk factors for both forms of abuse) can
be evaluated and intervened upon if they are associated with violence in a given family. The
simultaneous presence of a broad range of clinical problems—in addition to those of domestic
violence and child abuse—complicates treatment planning and delivery considerably.
C h i l d r e n i n d o m e s t i c a l l y v i o l e n t f a m i l i e s a r e a t s u b s t a n t i a l l y e l e v a t e d r i s k f o r p h y s i c a l c h i l d
abuse compared with children in homes without domestic violence. It appears that the most
typical pattern of co-occurring abuse is that both parents aggress against each other and one
or both aggress against the child. Assessing for child abuse in domestically violent families
is prudent both from the perspective of protecting children and from the perspective of
informing treatment planning. Such assessment is best conducted in the context of well-
delineated policies that will help the clinician and clients avoid some of the potential pitfalls
of incorporating such assessment into domestic violence services. Treatment plans should
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A c k n o w l e d g m e n t s . This research was supported in part by a grant from the National Institute on
Mental Health (MH53380).
C o r r e s p o n d e n c e r e g a r d i n g t h i s a r t i c l e s h o u l d b e d i r e c t e d t o E r n e s t N . J o u r i l e s , P h D , D e p a r t m e n t
of Psychology, Southern Methodist University, P.O. Box 750442, Dallas, TX 75275–0442. E-mail: