Family violence is easier to tackle when it is discussed directly

According to Professor of Nursing Science Eija Paavilainen, violence in families with children is far too prevalent in Finland. Paavilainen says that she was taken aback by her research group’s recent finding of how well-hidden violence is in Finnish families.

The FinChildren project described and compared how the parents of four-year-olds and public health nurses identify families’ support needs. The project data on 7,476 families included the survey responses of one parent per client family and one of their nurses.

According to the results, 47% of parents reported family violence. In their responses, 3,503 families mentioned either intimate partner violence, the physical or mental abuse of children or child maltreatment. The nurses, who did not see the families’ answers, estimated that only 1% of the families needed support because of violence.

– Public health nurses identify just a fraction of family violence. Our results highlight the fact that violence is extremely well hidden in families. Even though we had been aware of unseen forms of violence, I was astounded by the vast differences in the nurses’ and families’ experiences, Paavilainen says.

Nevertheless, the public health nurses identified families’ support needs when they concerned, e.g., coping, child rearing practices, interaction, and the mental well-being of family members. Paavilainen points out that these are the same aspects which international research has found to be risk factors of child maltreatment. Identifying risk factors efficiently provides an opportunity to intervene.

– It is good that the risks are identified, but that should lead to a more active identification of the families at risk. At present, violence is largely ignored in discussions, Paavilainen says.

At best, identifying risks means getting to discuss families’ worries and support needs. The researchers found that the early identification of problems and supporting the families at risk also help to prevent the recurrence of violence.

Mobile app identifies risks and refers clients to support

Paavilainen understands that parents do not always find it easy to talk about the family’s situation or experiences of violence with professionals even when they wish to be helped.

– That is why professionals should have the courage to take the first step. In the discussion that follows, it is possible to talk about violence and offer the family multi-professional support for overcoming the problems, she says.

Paavilainen is interested in risk assessment tools for spotting families in need of help. In 2022, the family violence research group she is leading compiled a list of risk conditions under which child maltreatment may occur. The list has been included in the National Clinical Guidelines (www.hotus.fi) in Finland. It comprises questions that make it easier for practitioners to bring up violence with their clients.

One of the tools for addressing risk conditions is a check list, which was developed as part of an international research project. The check list was turned into a mobile application in a research project led by Tampere University.

After the risk assessment, the idea is to refer the person to counselling as soon as possible to avoid the escalation of problems.

– Just by mapping the risks we cannot say that some single issue or family situation would cause family violence, but many factors increase the risk, Paavilainen points out.

The app contains information on maltreatment and 28 statements on the respondent’s situation. The app gives feedback based on the answers and refers the parent to support services, such as a child health clinic. The app is anonymous and does not collect user data.

The two-year EU-funded project included seven European partners. The app was translated into the languages of the project, and the partners are now piloting the outcomes.

Doctoral researcher Heidi Rantanen from Paavilainen’s research group is testing and finalising the mobile app. She has interviewed experts by experience on how well the issues that have been defined as risk factors correspond to people’s experiences of family violence. The app’s customer friendliness and usability have been improved based on the interview data. The application is currently also being tested by family and child services.

– The app has aroused much interest because health care workers clearly need a tool to facilitate starting difficult conversations. It is a problem if a professional can see that things are not okay but does not have the courage to ask what is happening or does not know how to call a spade a spade, Paavilainen says.

Putting oneself into the shoes of children helps

Paavilainen’s research project is studying child maltreatment that manifests itself differently than forms of, e.g., sexual abuse. The project understands maltreatment not only as physical maltreatment but also as an emotional one or neglect.

– We talk about maltreatment because violence as a concept often indicates intent. Maltreatment can also be unintentional. It may stem from a parent’s exhaustion which can make him or her shout at the child. Maltreatment also includes ignoring the child, Paavilainen explains.

At the beginning of 2024, the family violence research group began the Research Council of Finland-funded STOPCEM_VR project (Paavilainen; Kangas). With the funding, Tampere University has set up a consortium where Postdoctoral Research Fellow Pia Keiski and Paavilainen are producing contents for the VR app, i.e. writing descriptions of situations that involve maltreatment. At the same time, information technology researchers Jari Kangas and Mikko Partanen are designing the technical application for VR. Kangas’s group is already implementing the first virtual prototype where participants can experience the world through the eyes of a child.

Typical situations are parents’ quarrels when they are not aware that the disagreements can cause children distress.

– Parents do not always understand how children are feeling in such situations. Using a VR headset they can see such situations from the child’s perspective, which may make them realise how unpleasant quarrelling is and get an incentive to think about it further, Paavilainen says.

Public health nurses play a key role

Paavilainen’s research group is conducting wide-ranging research on family violence and child maltreatment. The group has, for example, used register-based data to investigate the long-term effects of intimate partner violence during pregnancy. Paavilainen points out that statistical data alone does not give a full picture of family violence. That is why the study is collecting interview data on things that have happened in the families. This data collection method enables accessing the families’ wishes for the future and targeting services to them. According to Paavilainen, it is important to investigate the effects of care, i.e. to find out what kind of counselling and interventions will produce the best results.

Adjunct Professor Aune Flinck, a member of the research group, has also written an autofiction on violence that occurs in close relationships and its inter-generational effects. (In Finnish)

– Parents usually wish that things were talked more directly. Research findings also suggests that people like it when spades are called spades. People can be startled at first when they are directly asked about violence and they may deny everything, but when things are hashed out, a fruitful conversation generally ensues. However, all such conversations must be based on trust so that the ideas can be expanded to supporting the family, Paavilainen emphasises.

In Finland, public health nurses play a key role in identifying violence and circumstances involving risks. They regularly meet families and examine and assess children’s health and wellbeing until the age of 7. At school age, school health services are responsible for promoting health among the pupils.

Research article:

Families of four-year-old children experiencing violence: A national survey of parents and public health nurses on help and support. Tuija Leppäkoski, Maaret Vuorenmaa, Eija Paavilainen (2023).