As a family nurse practitioner in Baltimore eight years ago, Benita Walton-Moss saw many survivors of domestic violence.

The most common injuries she treated were bruises, cuts and scrapes, but over time the abuse sometimes escalated to rape, broken bones or concussions. Walton-Moss, now a clinical associate professor in the Department of Nursing at the USC Suzanne Dworak-Peck School of Social Work, would also see many victims with neglected conditions stemming from past abuse, including sexually transmitted diseases and chronic headaches due to head trauma.

“Unfortunately, one of main trends is that even after a bad episode, victims don’t have plans to leave because they lack the financial means to go anywhere else, and often have kids with the abuser,” said Walton-Moss, who teaches a course on advanced health assessment across the lifespan that includes checking for signs of domestic violence, also called intimate partner violence (IPV).

Walton-Moss has conducted two prominent and often cited studies regarding IPV. The first in 2005 found that characteristics of the abuser most associated with the risk for IPV were not graduating from high school, problems with drugs or alcohol, self-reporting poor or fair mental health, and being suicidal. This was also one of the first studies to identify pet abuse as a significant risk factor for human abuse. Her 2006 study confirmed the critical role of control in physically violent relationships.

“The beginning of IPV can often be very subtle,” Walton-Moss said. “The controlling behavior can include calling someone names or keeping them away from others. Often violence goes two ways in both heterosexual and homosexual relationships. With heterosexuals, sometimes women may start [the controlling behavior], then men want to control, and usually men end up being the dominant abusers.”

Another form of control can be to make victims feel confused or crazy. “A friend told me that one of the first instances of abuse she experienced was when her abuser pushed her over a chair,” said CarolAnn Peterson, adjunct professor in the school’s Department of Children, Youth and Families. “When she asked why, he said he didn’t do it, that she tripped. Victims also learn patterns of behavior to try to appease the victimizers, but they find that it’s never enough because the abuser will change the rules.”

Focus on education and advocacy

Sexually abused by a partner when she was a young woman, Peterson has been immersed in understanding and addressing domestic violence for 35 years, providing consultation and training on the subject and designing services for domestic violence victims. She serves as a member of the Los Angeles Mayor’s Domestic Violence Steering Committee, which is determining how to enhance services provided to abuse victims in shelters.

Peterson created the school’s course on domestic violence and is one of nine faculty members who rotate teaching it.

“The course has evolved,” she said, “and now includes much more focus on how cultures -- LGBT, immigrant, racial minority, military, religious -- influence relationships and thought processes.” It also includes the topics of sexual assaults on college campuses and child abuse. A new course component is being developed on how to get witnesses of abuse to take action, and in the future Peterson hopes to include a segment on traumatic brain injury.

For children who witness domestic violence, there can be lasting consequences. “We know that most kids in abusive homes grow up to be abusers or victims because that’s what they learn,” Peterson explained. She cited the National Woman Abuse Prevention Project in Washington, D.C., which found children in homes where domestic violence occurs are physically abused or seriously neglected at a rate 1,500 percent higher than the national average.

However, scientific advances now indicate that long-term issues for children who witness IPV are not inevitable.

“We now know through neurobiology that it’s not what happened to you that determines future outcomes but how you make sense of what happened to you that determines future outcomes, so it’s important for children to have safe relationships to develop resilience,” said Susan Hess, clinical assistant professor of field education in the Children, Youth and Families department.

Changing the way we think

Domestic abuse can also have an impact at the other end of the lifecycle. Maria Aranda, associate professor in the Department of Adult Mental Health and Wellness who holds a joint appointment in the USC Leonard Davis School of Gerontology, points to statistics cited by the National Center on Elder Abuse: every year an estimated five million older Americans are victims of elder abuse, neglect or exploitation, and for every case of elder abuse or neglect reported, as many as 23 go unreported.

“There is a societal misinterpretation and denial that elder abuse can occur,” Aranda said. “People think, ‘these are adults, so how could they allow this to occur in their lives?’ There’s denial that family members would cause physical or sexual injuries to an older person, and denial puts a mask on the extent of the problem.”

One sign of progress in the area of IPV has been in the way social workers, policy makers and service providers incorporate trauma-informed approaches on micro, mezzo and macro levels.

“There was and is a clear need within IPV agencies to change the paradigm from a ‘power over’ approach to a ‘power with’ approach,” Hess said. “Trauma-informed care changes the question from ‘what’s wrong with you?’ to understanding ‘what happened to you?’”

Overall, Peterson said, progress has been made on a number of fronts in addressing and preventing domestic violence: better funding of shelters for IPV victims by local, state and federal governments; expanded restraining orders that include pets and livestock; removal of a gun or prohibiting the buying of a gun if California residents fear for their lives because of an abusive family member; eligibility for unemployment if a California resident leaves a job because of abuse at work; and members of the military losing their jobs or prohibited from carrying guns if convicted of domestic violence.

“As difficult and overwhelming as domestic violence can be for both victims and victim advocates, there is a light at the end of tunnel,” she said. “We just need to be united in our efforts and know that together we can all become survivors.”