Examining the Relationship Between Cumulative Trauma and Batterer Intervention Program Outcomes

Background:  Successful batterer rehabilitation is a critical strategy towards eliminating family violence.  To date, evidence supporting the effectiveness of batterer intervention programs (BIPs) has been mixed. Research consistently documents high attrition and recidivism rates among BIP participants that range as high as 75%. BIPs have also been criticized for failing to respond to the diverse and complex range of needs presented across batterers. Cumulative trauma, measured by adverse childhood experiences (ACE), is associated with adolescent and adult intimate partner violence perpetration, as well as substance abuse and mental health challenges that potentially hinder positive BIP engagement and treatment effects. This study examines the relationship between cumulative trauma and BIP treatment outcomes, specifically the association between cumulative ACEs and likelihood of BIP completion.

Methods: A secondary analysis was conducted with administrative data collected from BIP participants (n=282) enrolled over a two-year period. Participant intake data included: ACE total score and type: abuse (physical, sexual, emotional), neglect (physical, emotional), and household dysfunction (mental illness, substance abuse, incarceration, violence, divorce), gender, age, and race. Data was also provided about BIP treatment outcomes, including program completion and number of sessions completed. Descriptive, bivariate, and multivariate statistical analyses were conducted to test hypotheses about the ACE prevalence and impact upon treatment outcomes.

Results: Sixty-nine percent of the sample (n=193) reported experiencing at least one ACE. Twenty-six percent of participants (n=73) reported experiencing abuse, 22% (n=62) reported experiencing neglect, and 64% (n=181) reported experiencing household dysfunction. Consistent with our hypotheses, BIP participants reported higher rates of ACEs than the general population with almost one third reporting three or more ACEs. Logistic regression revealed total number of ACEs to be a significant predictor of program termination with individuals experiencing 3 or more ACE having 2.5 greater odds of being terminated from the program.  Some types of ACEs were more powerful predictors than others. For example, participants who experienced household dysfunction during childhood had 1.78 greater odds of program termination than those who did not.

Conclusion: Findings strengthen the evidence that batterers experience higher than average rates of cumulative trauma. Further BIP participants who have history of cumulative trauma appear to be less successful in standardized BIP treatment. Effective BIP strategies should consider the impact of ACEs on participants’ ability to successfully engage, comply, and benefit from treatment.  Additional research and intervention development is needed to improve the overall effectiveness of BIPs, especially among those batterers with a cumulative trauma background.