Feb 2, 2009
Commentary – Motivational Interviewing (MI), Child Maltreatment (CM), and Intimate Partner Violence (IPV): Challenges and Opportunities
Lonna Davis, Family Violence Prevention Fund
Correspondence should be directed to Lonna@endabuse.org.
IPV and Child Maltreatment
The significant connection between IPV and child abuse has been widely documented. In a review of studies examining the overlap of IPV and CM, it is estimated that the median occurrence for both problems to exist in the child protection caseload is approximately 40% (Appel & Holden, 1998). Given this overlap, all strategies for the reduction of child abuse must first inquire about the possibility for IPV or these strategies run the risk of being ineffective, causing unintended consequences, or even resulting in further harm.
Whereas, many child welfare and child abuse prevention programs reluctantly acknowledge or address gender in their language and interventions, it is clear that most victims of IPV in the child protection system are mothers. Likewise, men, in their role of husbands, boyfriends and fathers, are often the offenders, and, at the same time, are largely ignored by our interventions. These distinctions are extremely important as we advance our knowledge and practice in the child abuse prevention, as we need differentiated interventions for victims and abusers of IPV.
One significant challenge in the child protection system is that it holds mothers responsible for their choices (i.e. whom they pick as partners) and further holds them responsible for the way in which these choices impact their children. But in cases of IPV, it is clear that mothers are by no means responsible for their partners’ violence. If child abuse prevention programs want to stop child abuse, we must turn our collective attention to stopping offenders of IPV and increasing our support for victims and their children. This reframing of current policy and practice will not only unlock a bottleneck between the fields of domestic violence and child abuse, it can provide increased safety for women and children and ultimately offer men more opportunities for change.
MI and victims of IPV
Many of the core principles of MI can be employed with victims of IPV with important modifications. The first one centers on the intended design of MI- to reduce resistance for change. This element puts the onus on the victim and assumes that she is somehow responsible for the abuse and able to make a change that will result in stopping the violence and therefore reducing the impact and harm to her children. This thinking, although understandable on a surface level, can be very problematic in cases of IPV.
In the article “Integrating Motivational Interviewing into Home-Based Child Maltreatment Prevention and Family Preservation Services”, the authors make it clear that there is a difference between relationship problems and IPV but do not dissect the difference to help practitioners differentiate between these issues. They also acknowledge that there are many failed attempts by child abuse prevention practitioners and programs to adequately screen and assess for IPV. These core activities of screening and assessment should be employed regardless of the problem that MI will address. For example, some mothers’ substance use may be a consequence of IPV. Offenders who are trying to control their partners’ mind and body can use substances to help them achieve this goal. Women often share stories of coerced and forced substance use. Other mothers may be severely depressed because of the violence and may use substances as a means of self-medication.
That being said, I believe there is a way to use MI in cases of IPV as long as strict safety protocols are employed. A full explanation of safety protocols is beyond the scope of this paper but many examples exist to avoid re-creating the wheel for home-based service providers.
In fact, many tenets of MI and family-centered practice are considered good strategies for working with victims of IPV and have been utilized (under a different name) by advocates for battered women for the last thirty years. A collaborative, evocative approach that is committed to the autonomy and self-agency of victims is a sound and effective strategy. This has been proven in the last two decades by the work that has been developed by advocates in close collaboration with CPS workers. Together, they have created practices that are consistent with the values of family centered practice, such as:
Developing empathy for both the mother and child’s experience
Using self-generated values and acknowledgement of the internal conflict that mothers experience
Understanding that resistance is not the same as denial. Resistance is often a reaction to an intimidating systems intervention and/or uninformed strategies. For example, a worker who attempts to talk to parents together about what is wrong at their house may not get the same motivation for change because the approach is not a safe one for the victim to disclose. Fear of the system itself and fear of retribution by the partner are significant problems that are often named resistance
Empowering women to make choices about their lives and their children’s lives by offering them a full picture of what consequences (both positive and negative) connect with different choices
MI and offenders of IPV
In 1990, advocates for battered women began to work in the field of child abuse and neglect. Within the first year of work, they realized that there were systemic gaps in the policies and practices that were used in cases that involved both IPV and CM. On one hand there were strategies that put the onus on the victims of IPV, such as asking them to comply with unrealistic service plans or forcing them to obtain restraining orders. On the other hand, offenders of IPV were either ignored or in some cases, held accountable exclusively through the criminal justice system. Over the years, through strong relationships with Batterer Intervention Programs (BIP’s), practitioners have been learning how to engage men and fathers who use violence while keeping accountability central to the intervention.
Although traditional approaches for men who have used violence have focused on a cognitive behavioral approach, research has shown that BIP’s are most effective when they work in concert with other systems and community leaders to hold an offender accountable for their violence (Gondlof, 2002). This wide circle of law enforcement, judicial officers, community leaders, CPS staff, and others send a strong message that violence will not be tolerated and when authorities keep a watchful eye, long term success is more likely.
Although this approach has considerable merit, this over reliance on the criminal justice system has contributed to a gross over representation of men of color in BIP programs. This problem has led many activists and men and women of color to confront the cognitive only approach and enhance it with other strategies for engagement. One example, which is in concert with a core principle of MI, is the concept of using self-generated values.
This approach focuses on helping a man who uses violence to explore his cultural values more effectively in order to increase his motivation for change, as opposed to telling him what values the dominant culture wants him to abide to. Another emerging practice is the exploration of fatherhood as motivation for change. In cases where abusive men have been exposed to IPV as children, this strategy may be even more effective. One way to help men increase their own beliefs about their potential to execute real changes in their behavior is to help them see that they have the power to break a cycle of intergenerational IPV as opposed to perpetuating it. Most men have had examples of positive fatherhood in their lives (although some men may have to work hard to find one). These examples of positive fatherhood can begin to inspire abusive men and fathers toward change.
While there are no rigorous studies to date to support the fatherhood approach as an evidence-based practice, preliminary data suggest that this work with men and fathers is a promising practice that deserves more attention. Some programs in the US and abroad have been able to use this approach and successfully engage abusive men.
The challenges and opportunities presented here are intended to be points for further discussion and exploration. Safety for all victims of IPV and CM must always be at the forefront of our practice. Addressing IPV in the context of CM prevention must be done safely and sensitively. Without the identification of IPV and new tools to effectively intervene with victims and perpetrators, child abuse prevention programs will not get the outcomes they are trying to achieve. Safety protocols, screening questions, assessment tools and other structural mechanisms must be in place to begin careful entry into the field of home visitation and family preservation services.