Research at the Office of Justice Programs (OJP)
Evidence Integration: Children Exposed to Violence (CEV)
Children may experience crime, violence, and abuse in their homes, in school, and in their communities, and these experiences accumulate over time. Whether a child is a direct victim or a witness to violent events, childhood exposure to violence has been demonstrated to cause a range of subsequent difficulties and challenges for the individuals themselves, as well as for families and communities. Understanding and addressing children exposed to violence (CEV) requires a multi-disciplinary approach that is not limited by the specific nature or location of the violence or the relationship of the parties involved.
This review and synthesis of evidence related to CEV reveals that CEV: (1) affects a significant number of children in the United States; (2) may have significant negative outcomes, particularly when children are exposed to multiple forms of violence; and (3) is related to a variety of known risk factors. In addition to specific evidence-based programs that can be found on CrimeSolutions.gov, this review identified characteristics associated with successful practices.
A study of a national sample of American children found that over the past year 60 percent were exposed to violence, crime, or abuse in their homes, schools, and communities. Almost 40 percent of American children were direct victims of 2 or more violent acts, and 1 in 10 were victims of violence 5 or more times. Children are more likely to be exposed to violence and crime than adults. Almost 1 in 10 American children saw one family member assault another family member, and more than 25 percent had been exposed to family violence during their life (Finkelhor et al., 2009).
The term poly-victimization describes individuals who have experienced multiple victimizations of different kinds, such as sexual assault and bullying, or witnessing intimate partner violence and physical abuse. Nearly half of a national sample of children had experienced at least 2 different kinds of victimizations in the past year (Finkelhor et al., 2007). Over the course of their lifetimes, 66 percent experienced 2 or more types of violence, 30 percent experienced 5 or more types and 10 percent experienced more than 10 different types of violence (Turner et al., 2010). Over the course of their lifetimes, 57 percent of the children who had witnessed intimate partner violence were also direct victims of child maltreatment (Hamby et al., in press).
Factors that increase children’s risk of being exposed to violence include:
Outcomes of Children Exposed to Violence
- Age: Older children are exposed to more serious forms of violence and are more likely to be victims of multiple kinds of violence (Finkelhor et al., 2009; Finkelhor et al., 2007a; Baum, 2005).
- Gender: Boys are exposed to higher rates of physical assault than girls (Finkelhor et al., 2009; Kilpatrick et al., 2003; Stein et al., 2003; Woodward & Fergusson, 2000). Girls are exposed to higher rates of sexual victimization than boys (CDC, 2010; Finkelhor et al., 2009; Finkelhor et al., 2007a; Kilpatrick et al., 2003; Small & Zweig, 2007; Theodore et al., 2005).
- Race and ethnicity: Overall lifetime rates of exposure to violence are higher among black and Native American adolescents (Kilpatrick et al., 2003).
- Family structure: Children who do not live with both biological parents are at increased risk of exposure to violence, especially for experiencing physical and sexual assault perpetrated by a family member and witnessing domestic and community violence (Hanson et al., 2006).
- Family alcohol problems/drug use: Risk for exposure to violence and risk of experiencing multiple victimization episodes was higher when family alcohol problems or drug use were present (Stevens et al., 2005; Hanson et al., 2006).
- Intimate partner violence: Children from families where intimate partner violence was present had an increased risk of subsequent child maltreatment victimization (McGuigan & Pratt, 2001; Rumm et al., 2000).
- Peer delinquency: Children who associate with more deviant or delinquent peers in one year are at higher risk for exposure to community violence in the next year (Salzinger et al., 2006; Lambert et al., 2005).
- Prior Victimization: Children who experienced one type of victimization in the past year had double or even triple the risk of other types of victimization. These risks held true for lifetime exposure as well (Finkelhor et al., 2009).
Outcomes for children exposed to violence are often overlapping, with children experiencing multiple problems. Any one of the identified outcomes has multiple risk factors other than exposure to violence which makes establishing a causal link between exposure to violence and any specific outcome extremely challenging (Saunders, 2003).
Psychological health outcomes
These include problems associated with depression, anxiety, post-traumatic stress disorder, isolation, shame, fear, guilt, and low self-esteem (Bourassa, 2007; Finkelhor et al., 2009; Johnson et al., 2002; Moylan et al., 2010; Kilpatrick et al., 2003).
Physical health outcomes
Children exposed to violence are at risk for physical injury and are also more likely than others to have poor overall health, have illnesses requiring medical attention, attempt suicide, or be involved in self-injury (Duke et al., 2010; Finkelhor et al., 2009; Flaherty et al., 2009). There is evidence that exposure to child abuse and neglect has profound effects on brain development and cognition (Child Welfare Information Gateway, 2009).
Academic difficulties and failure
Exposure to violence increases the risk that children will drop out of school or do more poorly in school (Herrenkohl et al., 2008; Holt et al., 2007).
Behavioral outcomes may include substance abuse or dependence, teen pregnancy, aggression, conduct disorder, delinquency, and violence, including dating violence and intimate partner violence (Bourassa, 2007; Duke et al., 2010; Ehrensaft et al., 2003; Finkelhor et al., 2009; Herrenkohl et al., 2008; Johnson et al., 2002; Kilpatrick et al., 2003; McCabe et al., 2005; Moylan et al., 2010; Nofzinger & Kurtz, 2005).
Delinquency and offending
High rates of victimization are seen in juvenile justice samples. Seventy percent of youth in residential placement had some type of past traumatic experience, with 30 percent having experienced frequent and/or injurious physical and/or sexual abuse (Sedlak & McPherson, 2010). Some types of victimizations are more strongly associated with violent offending than others (Nofzinger & Kurtz, 2005). Sexual victimization is not predictive of violent offending, whereas victims of child physical abuse are approximately 1.7 times more likely than others to be involved in perpetrating violent offenses. Being the victim of a physical assault increases the likelihood of violent juvenile offending by 3.3 times (Nofzinger & Kurtz, 2005).
A number of studies have found that exposure to multiple kinds of violence predicts negative outcomes beyond the effects of any specific type of exposure. The range of outcomes includes psychological distress, adjustment in adult relationships, college adjustment, school grades, physical health, teen pregnancy, delinquency, bullying, self-directed violence, physical fighting, teen dating violence perpetration, and adult intimate partner violence victimization and perpetration (Duke et al., 2010; Richmond et al., 2009; Elliott et al., 2009; Holt et al., 2007; Flaherty et al., 2009; Sternberg et al., 2006; Finkelhor et al., 2007a; Turner et al., 2010; Anda et al., 2001; Whitfield et al., 2003; Spriggs et al., 2009).
CrimeSolutions.gov includes information about evidence-based programs that are promising and effective at addressing issues related to CEV. Beyond evidence about specific programs, this review identified principles and characteristics associated with successful practices. These include:
To advance practice, there is a need for:
- Engaging and intervening with both the parent and child
- Combined home-based and center-based approaches
- Multi-modal approaches (combining individual, group, family, advocacy, case-management and/or combining treatment approaches)
- Parent training as prevention and intervention
- Psycho-educational roles for all providers across all aspects of the continuum
- System partners that interact with children and families from prevention to response
- Common measures and definitions for both research and practice so that research findings can be compared, analyzed, and applied.
- Further development of screening and risk assessment tools using poly-victimization indicators.
- More focused attention to poly-victims in delivering and distributing resources and services.
- Further training and cross-training for multiple disciplines on CEV.
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Also see the following CrimeSolutions.gov pages for program information and related materials: