Mothercraft’s Breaking the Cycle is a Toronto-based CAPC program for pregnant women and mothers with substance use problems and their children.  Margaret Leslie, Director, Early Intervention Programs, Mothercraft/Breaking the Cycle presents the training webinar on their newly developed Building Connections resource manual. The webinar focuses on highlights of key messages in the Building Connections resource manual, and is designed:

• To introduce the Building Connections resource manual
• To support an understanding of the impacts of IPV on women, mothering and children
• To introduce trauma-informed and relational approaches in responding to mothers and children living with IPV

The topics in the webinar include:

• Development of the Building Connections resource manual
• Setting the stage for understanding Interpersonal Violence (IPV)
• Impacts of IPT on mothering and child development
• Identification of IPV and prevention of trauma responses
• Supporting safety for women and children living with IPV
• Developing trauma-informed responses to IPV
• Role of community programs

The manual was developed through literature review, focus groups, and key informant interviews.  Although the overall issues of IPV are wider in scope, the manual limits its focus to women, mothers and children.

Interpersonal Violence:  because mothers who experience violence in adult relationships have often experienced childhood abuse and trauma, or have witnessed violence in their own families.  What women have learned in their childhood experiences affects the relationships they are likely to have with their adult partners and with their children.

Interpersonal Violence can take many forms:

• Physical abuse
• Emotional abuse
• Economic abuse
• Sexual abuse
• Spiritual abuse
• Criminal harassment/stalking
• Digital (or electronic or technological) abuse

Setting the stage for understanding IPV:

• Half of all women in Canada have had at least one incident of physical or sexual violence since the age of 16.
• Most women with abusive partners do not involve the police or service providers.
• Children under age 5 are more likely to live in a household where IPV occurs than are children in any other age category.
• Children are affected by IPV.
• IPV often begins or increases during or after pregnancy.  As many as 25% of women have experienced IPV during pregnancy.
• IPV occurs in all ages, races, cultures, and socio-economic, education and religious groups.

• But it is more likely to occur with certain groups of women and men.

Some women are more likely than others to experience IPV:

• Women under 25 years with young children
• Women who have experienced or witnessed IPV in childhood
• Poor women, unemployed women and women otherwise marginalized from society
• Pregnant women
• Indigenous women
• Women who live with heavy drinkers or other drug users
• Women in common-law relationships rather than legal marriages
• Women from cultures where gender-based violence is the norm
• Women recently separated or in the process of ending a relationship

The issue of IPV has direct links to social determinants of health, so programs that address social determinants of health are in a strong position to offer support to those experiencing IPV.

Some men are more likely than others to be abusive:

• Men who are under 25 years of age
• Men who have a history of being abused as children or witnessing IPV in childhood
• Men who have less education, are unemployed, are low income, and are otherwise marginalized from society
• Men who have not had positive relationships or role models and so they see violence as a normal part of life
• Men who use alcohol and other drugs problematically
• Men who have a past history of being abusive
• Men who accept traditional gender roles

IPV and trauma:

• Both women who are abused and their abusers are likely to have had trauma experiences
• There is a strong relationship between childhood maltreatment and violence in adult relationships:
  • Almost half (48%) of women who experience IPV as adults also have experienced physical and/or sexual abuse as a child
  • About 20% of women who experience IPV witnessed abuse committed by a parent, step-parent or guardian as a child

Childhood maltreatment, trauma, and IPV:

• Children who were not kept safe by their own parents or who were exposed to violent relationships and early traumatic stress:
  • Often have confused expectations and perceptions of ‘normal’ relationships
  • May not have an understanding of safety in relationships
  • May have developed a high tolerance for danger and maltreatment in relationships

The impact of early traumatic stress can interfere with:

• A mother’s ability to assess her own safety and the safety of her children: a high tolerance for danger and violence
• Her ability to regulate her emotions and behaviour
• Her sense of self and values
• Her perception of control over a situation
• Her belief in herself and her ability to change – a low sense of self-efficacy, that she doesn’t have the power to change
• Her interpersonal relationships

Interpersonal violence is linked to mental health problems for women:

• Depression, anxiety disorders and post-traumatic stress disorder (PTSD)
• Sleep disorders and eating disorders
• Misuse of alcohol and other drugs
• Symptoms of the underlying trauma

Parenting by mothers living with IPV:

• She might have to focus on safety, survival and meeting the abuser’s needs more than nurturing her children.
• Stress induced by living with IPV can result in child maltreatment.
• A mother might not know the extent of the effects of IPV on her children – this was a salient theme that arose in most of the parental interviews.
• She might have mental health issues, substance use problems, or poor physical health caused by living with IPV.  Mothers and children living with IPV are often coping with multiple challenging issues.
• Her mothering may be undermined by her abuser; he may threaten to report her to child protection services.
• Her shame and guilt about IPV can interfere with access to support services.  Access to support services can make a significant positive difference for mothers and children.

Some ways children are affected by IPV:

• Children can come to believe that IPV is inevitable or normal in relationships
• Children may learn to view the world as unpredictable and unsafe
• Children can develop negative core beliefs
• Children are exposed to toxic stress, which affects brain development, attachment and regulation in the early years
• Children can be isolated from helpful sources of support

Toxic stress:

• Strong, frequent or prolonged activation of the stress management system
• Events are chronic, uncontrollable and unpredictable
• Events are experienced without access to support from caring adults
• Has an adverse effect on brain development
• Has an adverse effect on mental health – anxiety, depression, helplessness, dissociation
• Has an adverse effect on regulation – sleeping, eating, emotion modulation

Cues that a mother might be living with IPV:

• She defends, excuses, minimizes or apologizes for her partner’s behaviour
• She lacks confidence or seems overwhelmed in her role as a parent
• She describes herself as either overly permissive or overly strict to compensate for her partner’s behaviour or parenting style
• You have reason to believe she is abusing substances
• She used harsh discipline
• Her children display disrespectful behaviour toward her and/or her children seem to take a caregiver role with her
• You observe bruising or injuries

Cues that a child might be living with IPV:

• Physical complaints: stomach aches and headaches that could be related to anxiety or stress
• Problems with regulation:  such as sleep difficulties, changes or disruptions in eating habits, lack of emotional control (irritability, excessive crying, temper tantrums)
• Signs of disorganized attachment:  fear responses; being passive or appearing helpless; being constantly on guard (hypervigilance); restricted play; clingy and showing separation anxiety (beyond what would be expected)
• Signs of maltreatment
• Developmental delays or regressions
• Behavioural problems:  aggression, poor impulse control, fear of being alone, immature behaviour

Supporting mothers living with IPV:

• Listening for comments/themes that may suggest IPV and finding ways to discuss them
• Asking about injuries, or patterns of injuries
• Using non-judgmental, caring and gentle approaches
• Understanding why mothers experiencing IPV stay in the relationship
• Understanding a mother’s actions and behaviours.
• Emphasize confidentiality
• Ensure privacy
• Allow women to tell their stories at their own pace
• Begin with the assumption that her behaviour is logical
• Reassure her that you want to understand her situation from her perspective
• Listen and don’t give advice.  Offer support and choices.
• Let her know she is not alone
• Help restore her belief in her own mothering; positive messages about mothering
  • There are no perfect mothers
  • Mothers can change their lives and the lives of their children for the better
  • Single mothers can be strong, effective parents, and good role models for boys
  • There are service providers who can support mothering, even for women living with IPV
• Help her access information, resources and social supports

Supporting children living with IPV:

• Notice regressions in development
• Notice changes in regulation – eating and sleeping
• Notice changes in social-emotional development
• Be alert to signs of maltreatment
• Provide physically and emotionally safe spaces
• Provide structured programs that create predictability and routines for children
• Help children anticipate what will happen
• Provide reassurance when children need it
• Name children’s feelings
• Model nurturing, respectful behaviour and gender equality

Reporting responsibilities and requirements:

• Be familiar with mandatory reporting requirements
• In many jurisdictions, being exposed to IPV means a child is in need of protection
• Collaborative and positive relationships between community-based programs and child protection agencies help mothers engage more positively to promote safety for their children
• Help her to know that you want to join her in helping to keep her children safe

How to be trauma-informed:

• Service providers do not need to be specialists in trauma-specific treatment in order to implement trauma-informed practices.  Being trauma-informed means that service providers:
  • Understand trauma as a core issue for women
  • Understand the impact of trauma on women and children
• Trauma-informed practices do not require disclosure of details about a woman’s experiences of trauma

Providing trauma-informed support to children who live with IPV:

• Create calm, stable, and predictable environments
• Support mothers to help their children manage their emotions
• Be a role model
• Work collaboratively with other services for children in your community

Making community-based programs trauma-informed:

• Reflect on your program’s practices and policies
• Create an environment with regular opportunities to reflect
• Reflect on the impact of the work that you do on your own life
• Examine personal biases and experiences
• Be aware that vicarious trauma can interfere with ability to support and engage with women and children
• Provide staff with opportunities for training in trauma-informed practices and IPV
• Provide regular, reflective supervision
• Ensure that program policies and practices are trauma-informed
• Ensure that program spaces are physically and emotionally safe
• Establish relationships with community partners that will support women and children and promote their safety, resilience and healing

Role of community-based programs:  Community-based programs that provide a caring, consistent and structured environment help mothers and children feel safe and supported.  Service providers can support mothers to form secure attachment bonds and develop positive mothering strategies that will improve the lives of mothers and children who live with IPV.  Also, when programs develop strong and effective relationships with other helping services, the system as a whole becomes supportive and responsive to mothers and children who live with IPV.

The webinar includes a number of quotes from key informant interviews to illustrate key points in the manual, address some commonly held myths around IPV, and leaves the viewers with three points to consider:

• Helping Women Helps Children:  A strong relationship with a caring adult is one of the best protective factors for children.  It is the major contributing factor to their resilience.  The support that community-based programs provide to mothers helps children.  That support to mothers helps children overcome the effects of living with IPV.  And your support helps mothers and children learn about healthy relationships.
• It’s often not easy to talk about family problems:  IPV and other family problems are often treated with great secrecy.  Sometimes secrecy is a way of maintaining safety.  By asking caring, gentle questions, you will have let the woman know you are concerned and willing to help.  A mother might not talk to you right then.  But if you are open and compassionate, she might decide later that it’s safe to talk to you.
• Disclosure, and then change and healing, all take time and can’t be forced upon women by service providers.

Access the training webinar.