Severe Domestic Violence Research Articles

Assessing risk for severe domestic violence and related homicides perpetrated by partners and in-laws: adapted danger assessments for women in abusive relationships in India

Despite domestic violence and related homicides perpetrated by partners and/or in-laws being a significant public health problem in India, there are no reliable and valid instruments to identify and intervene with women in domestic violence relationships. Continued domestic violence can escalate to severe, near-lethal, or lethal violence or homicide. The Danger Assessment (DA) is a risk assessment instrument designed to assess the likelihood of severe, near-lethal, or lethal violence in abusive relationships. However, the DA is not designed to determine the risk of future severe, near-lethal, or lethal violence by in-laws. In-law abuse plays a significant role in domestic violence-related homicides in India and other countries with similar cultural norms. This study addressed this gap by developing the Danger Assessment for in-laws (DA-L) to assess risk from in-laws, alongside the Danger Assessment for Women in India (DA-WI) to assess risk from partners. The study also examined the psychometric properties of the DA-L and DA-WI. Longitudinal data from 150 women in India were used to measure the reliability and validity of the two versions of the DA. The original DA items and additional risk items were examined using relative risk ratios for their relationship with severe violence at three-month follow-ups. Predictive validity was tested with the receiver operating characteristic curve. The study resulted in reliable and valid measures (11 items DA-L and 26-items DA-WI) of risk. The versions of the DA can be useful for practitioners in India and those working with Indian women in the US and other countries. The DAs can be used for identifying women in domestic violence relationships who are at risk for future severe domestic violence and guide the provision of tailored safety plans.

Behind Closed Doors: The Persistence of Domestic Violence in Contemporary Indian Society

Introduction: Domestic abuse is a significant contributor to the nation's misdemeanor index, with destructive behavior in personal relationships where one person attempts to exert control and influence over another. This can occur in dating, marriage, or conjugal relationships and can lead to physical, psychological, or sexual harm. This work aims to explain the underlying reasons for domestic violence, which include various factors such as individual, relational, community, legal, and governmental elements. These components contribute to domestic abuse and its effects on the victim's emotional and physical well-being in daily life. The report also discusses the different forms of domestic violence, including physical, emotional, mental, sexual, economic, and teasing abuse. Objective: To assess domestic violence and its relation to human rights. Methods: The study was conducted in selected areas of Noida, Uttar Pradesh by two data collectors. A total of 60 women were selected using a convenience sampling technique. The questionnaires were checked for completeness, cleaned manually, and entered into SPSS version 25.0 for further analysis. Descriptive statistics were carried out, and associations between dependent and independent variables were checked. Results: The majority of the women (34 or 56.6%) experienced moderate domestic violence, 16 (26.6%) experienced severe domestic violence, and 10 (16.7%) experienced mild domestic violence. The education status of the women was found to be significantly associated with the level of domestic violence, with a p-value of less than 0.05. Conclusion: Urgent action is required to strengthen efforts to reduce violence and improve the availability of information on domestic abuse cases. These statistics are crucial for effectively combating domestic violence against women in India.

Women's rights and child abductions under the Hague Convention

AbstractThe Hague Convention on Civil Aspects of International Child Abduction is a multinational treaty designed to protect children internationally from the harmful effects of parental abduction. The Convention requires a mandatory return of a child who was wrongfully removed or retained outside the country of her habitual residence unless a narrow defense preventing return can be proven. When drafted, it was assumed that most abductors would be non‐custodial parents disappointed by an adverse custody decision in the home country. It is now clear that women have been disproportionately affected because in many, if not most, U.S. cases, the respondents, that is, the parents accused of the abduction, are the children's primary caregivers. When the child's home country is not willing or capable of protecting the mother and the child, they are forced to flee from often near‐lethal danger. Therefore, many cases brought under the Hague Convention involve severe domestic violence. The Hague Convention allows courts to deny the return if it would expose the child to a “grave risk of physical or psychological harm.” Nonetheless, a limited judicial understanding of domestic violence, coupled with societal gender biases, has impeded the application of this defense. Several recent developments discussed in this essay reflect a growing understanding of the lasting traumatic impact of domestic violence on these child victims.

Coping Strategies in Women and Children Living with Domestic Violence: Staying Alive.

Children exposed to domestic violence are at risk of adverse short- and long-term psychosocial effects and of being abused themselves. However, mothers and children face systemic gaps when seeking safety from domestic violence services and police. Safety planning typically focuses on women, overlooking their multiple social identities and excluding their children. We explored safety strategies used by mothers and children coping together with severe domestic violence. Interviews with 30 mothers who experienced severe or potentially life-threatening domestic violence and 5 adults who experienced domestic violence in childhood were qualitatively analyzed using thematic analysis, revealing five major themes: ongoing communication, appeasing the abuser, soothing activities, exposure reduction, and fostering independence. Interpreting participants' experiences in terms of the mother-child dyad, we found that mothers and their children worked together to reassure each other, keep each other safe, and make plans to leave their abuser. Safety planning for the mother-child dyad could build on children's existing coping strategies and recognize and support children's desire to protect their mother and themselves effectively and safely according to their developmental stage.

Battered Woman Syndrome: The Iceberg of Domestic Violence

As per its definition, Battered Woman Syndrome (BWS) is an unfortunate clinical condition related to woman’s prolonged and repeated exposure to the domestic violence. Most of the battered women do not ask for help (neither legal protection or therapy due to sustained psychological trauma) because of the children’s safety, and/or unsupportive legal and community services. Sadly, but vast majority of severe domestic violence became highlighted in the courtroom; however, not because of the batterer’s abuse and battery (which often include children) but because that battered woman is accused of killing her partner or caused grievous body injuries to him.

Domestic violence and psychological problems in married women during COVID-19 pandemic and lockdown: A community-based survey.

BackgroundFollowing the declaration of Coronavirus disease-2019 as a pandemic, a nation-wide lockdown was announced in India. This led to increase in psychological problems, especially in women.ObjectivesTo assess the prevalence of psychological problems and domestic violence (DV) in married women during the pandemic and lockdown in a panchayat in Southern India and to study the association of socio-demographic and clinical variables with psychological problems.Materials and methodsA cross-sectional study was undertaken in 209 married women of 18–55 years residing in a village panchayat of northern Kerala, India. Socio-demographic variables and clinical variables, like depressive symptoms, anxiety symptoms, perceived stress and DV, among others, were evaluated. The participants were interviewed by trained community health workers in the post-lockdown period.ResultsThe prevalence of depressive symptoms was found to be 10.0 %, anxiety symptoms 7.2 % and perceived stress 66.0 %. Severe DV was reported by 6.2 %; but at least one form of DV was experienced by 25.8 % of the women. Significant positive correlation was observed for DV with depression and anxiety. DV was also found to be a significant predictor of depression (adjusted OR [aOR] = 4.26, P = 0.006) and anxiety (aOR=4.34, P=0.02). Being a homemaker (aOR=4.51, P = 0.03) and having past history of mental illness (aOR=5.39, P = 0.03) were also found to increase the risk for depression significantly.ConclusionThere is a high prevalence of psychological problems in married women during the pandemic and lockdown. DV was found to be a significant predictor of depression and anxiety in this population.

"I'm Just Like, You Know What, It's Now or Never": Exploring How Women of Color Experiencing Severe Abuse and Homicide Risk Journey Toward Formal Help-Seeking.

Women in the United States are more likely to be killed by an intimate partner than anyone else, and prior, severe domestic violence (DV) is typically involved in such intimate partner homicides (IPH). Black women experience disproportionately high rates of DV and IPHs, severe injury, and abuse with weapons. Distinct patterns of escalating DV are associated with impending risk of re-victimization and lethal violence. One of the most common predictors associated with formal DV help-seeking is severity of physical violence. The current study uses semi-structured interviews with 11 severe abuse survivors to answer the following research questions: (1) How do women experiencing severe abuse make sense of DV resources across the course of their abusive relationships? (2) How do women experiencing severe abuse make sense of services when fear of death/homicide risk is present? Approximately 91% of the sample is comprised of women of color (WOC) survivors. Results demonstrate that WOC survivors navigated complex journeys toward formal DV help-seeking that involved resisting help-seeking when the abuse still felt manageable; delaying help-seeking to protect themselves from escalating violence; and hastening help-seeking when breaking points were reached and the risk of death felt tangible. DV resources took on a different meaning in participants' lives as abuse became more severe across the abuse lifecourse, and in relation to life circumstances and patterns of abuse, and personal perceptions of homicide risk. WOC participants also often experienced multiple structural barriers to formal help-seeking and waited until the violence was severe and/or life-threatening to make first contact, which highlights the necessity of immediate risk assessment with responsive service offerings that address the link between DV and poverty, as well as regular follow-up and ongoing support.

Determinants of Empowerment: An Insight from the Study of the Female Domestic Workers

Female domestic workers (FDW) are one of the most vulnerable segments of a society facing adverse social domination and economic discrimination. The present article aims at investigating to what extent the participation of poor women in economic activities empowers them. The study amalgamates data collected from 334 female domestic workers living in different areas of South 24 Parganas district of West Bengal through a semi-structured questionnaire during a period of 6 months from January 2016 to June 2016. This district was chosen on the basis of existing inter-linkage between the growth and expansion of the city of Kolkata in her southern part, existence of a large number of Bangladeshi migrants in South 24 Parganas ( Kumar, 2010 ), evidences of large scale commuting of unorganized workers ( Roy, 2003 ) and the expanding informal market where the supply of manual labour comes from the fringes of the district. The article tries to explore the different dimensions of empowerment from the study of female domestic workers. This includes workers’ involvement in taking household decision, free movement, possession of assets and restricting domestic violence. By adding the obtained scores and weights of the indicators, a cumulative empowerment index is constructed. Restrictions in mobility and lack of ownership of permanent assets amongst workers indicate their subordination in the household hierarchy and highlight that women are excluded from asserting influence over household properties. Severe domestic violence against women is common and visible even when husbands are unemployed. About 69 per cent of female domestic workers report incidences of physical assault at home. The index, thus, establishes that the majority of the domestic workers level of empowerment is between low to moderate.

Family Interaction Pattern in Wive’s of Alcohol Dependents

Introduction: Alcoholism is a disease which affects the individual and their family hence it is known as a family disease. Alcoholism reflects on the family bonds and it often leads to the complete breakdown of the entire family. The most affected persons are the wives of alcoholics because of their commonly nature and the intimacy in their relationships. The spouses of alcoholics facing severe domestic, financial and emotional violence which leads major psychological problems like anxiety, depression and poor self-esteem. Family interaction pattern (FIP) is defined as methods by which members of the family relate to each other through various mechanisms binding them in the bond of family. Aim: This research work has made an attempt to study the Family interaction pattern in wive’s of alcohol dependents. This study to measure the level of family interaction pattern and significant factors associated with wive’s of alcohol dependents of Kottayam district of Kerala, India. Result: Nearly half of the respondents (37%) have medium level of Family interaction pattern. 33% have high family interaction pattern and 30% have low level of family interaction pattern. The study reveals that FIP Score has significant difference with the variables like age, area of residence, education and duration of drinking habit in spouses. The post hoc test indicates that respondents between the age group of 31-40 years, rural area of residence, educated below 10th standard and above 10 years of drinking habit in spouses have better FIP. Religion, type of family, occupation and family monthly income has no significance. Conclusion: This study inspires in realizing the mental, social, marital and family relation among wive’s of alcoholics and it will be a great help in promoting family counselling programmes in de- addiction centres.

The impact of the Great Recession on California domestic violence events, and related hospitalizations and emergency service visits

ObjectiveExplore the impact of the Great Recession on domestic violence (DV) related hospitalizations and emergency department (ED) visits in California. MethodsHospital and ED data were drawn from California's Office of Statewide Health Planning and Development (OSHPD). DV-related hospitalizations and ED visits in California were analyzed between January 2000 and September 2015 (53,596), along with total medical costs. Time series were divided into pre-recession (Jan 2000-Nov 2007) and recession/post-recession (Dec 2007-Sept 2015) periods. ResultsThe medical cost of DV-related hospitalizations alone was estimated as $1,136,165,861. A dramatic increase in DV episodes was found potentially associated with the Great Recession. The number of ED visits per month tripled from pre- to post-recession (104.9 vs. 290.6), along with an increased number of hospitalizations (77.1 vs. 95.6); African Americans and Native Americans were disproportionally impacted. In addition, psychiatric comorbidities, severe DV episodes, in-hospital mortality and charge per hospitalization escalated. The rise in DV hospitalizations and ED visits beginning in December 2007 was mainly attributable to physical abuse episodes in adults; minors had no change in DV trends. DiscussionRecessions are frequent in modern economies and are repeated cyclically. Our study provides critical information on the effects of the 2007 financial crisis on DV-related healthcare service utilization in California. Given the current financial crisis associated with COVID-19, which expert predict could extend for years, the results from this study shine a spotlight on the importance of DV-related screening, prevention and response.

Policing the Penal Provisions on Repeated and SevereDomestic Violence

Policing the Penal Provisions on Repeated and SevereDomestic Violence

Facial Emotion Recognition in Maltreated Children: A Systematic Review

We systematically reviewed controlled studies published in the last 16 years about emotion recognition deficits in maltreated children. A bibliographical research of controlled studies, including only studies with samples larger than 10 participants, from 1998 to 2017, was conducted on Medline, Lilacs, PubMed and ISI. A total of 31 articles were included in this review. Abused children have a recognition bias for negative expressions, especially fear and anger. This increased perception tends to impair interpersonal relationships throughout their development. However, it appears as a matter of necessity, related to survival in a hostile environment. Moreover, neglected children have a shorter reaction time for recognition of negative facial expressions. Thus, the consequence of this deficit generates losses, such as the difficulty of ability to perceive a situation that puts them at risk. Children victims of severe domestic violence, as well as those who have been sexually abused and neglected, experience a learning situation regarding past experiences. The losses appear both in abnormal anatomical brain and physiological formations, as well as psychological and behavioral changes that impact the lives of these individuals. These changes are associated to changes mainly in circuits related to the prefrontal cortex and limbic regions, which are responsible for regulating the reaction to a threat. Future studies should develop programs, focusing not only in the prevention of adverse family environments and domestic violence, but also in helping these children improve psychosocial adaptation.

Active coping with trauma and domestic violence: How Afghan women survive

This personal reflection examines the author’s experience while conducting qualitative research on the traumatic life events and coping among the female workers in Kabul University’s dormitory for female students. It also describes the experiences of one of the study’s participants, a woman who suffered from severe domestic violence and enacted various ways of active coping.

Heterogeneity Within Domestic Violence Exposure: Young Adults' Retrospective Experiences.

Using Holden's taxonomy of domestic violence (DV) exposure as a guiding framework, the current study examined young adults' diverse DV exposure experiences. Twenty-five young adults (ages 19-25) exposed to father-perpetrated DV during their childhood and adolescence were interviewed using a qualitative descriptive design. Data analyses focused on coercive control exposure through reports of non-physical abuse tactics, types of exposure (e.g., direct, indirect), physical violence exposure (e.g., severity, frequency), and child abuse and harsh parenting practices. DV-exposed young adults were directly and indirectly exposed to physical violence and an array of non-physical abuse tactics toward their mothers. Young adults categorized as having been exposed to coercive controlling violence reported exposure to ongoing, non-physical abuse tactics and more frequent and severe physical violence. These young adults were also more likely to intervene and become victimized during physical violence and reported repeated episodes of child abuse and harsh parenting. Although coercive control appeared to be associated with physical violence and child abuse, generalizations should be made with caution as a few participants exposed to situational conflict were exposed to frequent and severe DV. The findings suggest that DV exposure should be measured in methodologically sophisticated ways to capture the heterogeneity in experiences, with the goal of promoting empirically driven intervention and prevention initiatives that are tailored to individual and family needs.

Involuntary First Admissions to a Tertiary Psychiatric Hospital in Cape Town: A Five Year Review of Family Referrals to Psychology

Background: Valkenberg Hospital is one of three tertiary psychiatric hospitals in Cape Town – and has a catchment area population of over one million. It is an acute admissions hospital for adults (18-59 years). Objectives: This article aimed to determine the psychosocial history of male patients involuntarily admitted to a high care psychiatric unit for the first time, and the needs and concerns of their families, to allow for the development of more appropriate services. Method: The psychology family clerking interviews (June 2007 – June 2012) of the Male High Care Unit (MHCU) of Valkenberg Psychiatric Hospital’s first admission families (FAF) were reviewed. All of the patients in the chart review were severely psychotic and had not been able to be managed at a secondary hospital level, which had necessitated their referral to Valkenberg. Each clerking interview with the family lasted 1.5 to 2 hours, and was conducted by the Intern Clinical Psychologist placed at Male Admissions. All 225 available folders were reviewed and coded. Results: The majority of the patients were young (mode = 21), still living at home (80%), single (90%) and unemployed (65%).More than 80% of the men were given a working diagnosis of either Substance Induced Psychotic Disorder (SIPD: 46%), Schizophrenia (27%) or Bipolar (11%). There was a strong family history of severe mental illness (SMI: 49 %), psychiatric admissions (30%), depression (26%), suicide (18%), substance use (SUD in parent/s: 45%, siblings: 36%) and domestic violence (30%). Most families suspected that the patient had used drugs and police had had to be involved in at least 40% of the admissions. Despite nearly half of the patients expressing regret at their substance use, more than half the families reported that the patient had become aggressive and that at some stage they had feared them. The families most identified the patients’ admission as their greatest stressor. The second most identified greatest stressor was finances, with 40% of the families being in debt and more than a third of the families being either unable to or financially struggling to visit the patient while he was admitted. Conclusion: For many patients and their families, the times before and during the admission had been long and traumatic. Family intervention was necessary to provide more effective help-seeking methods, and to provide services that simultaneously looked at co-morbid substance use, depression and anxiety, suicidal thinking, social isolation and domestic violence, often in the background of poverty. It was highly recommended that the development of services aimed at treating dual diagnosis (severe mental illness or the risk thereof, and substance use disorder) be developed and prioritised.

Editorial Introduction: Residential Services for Children and Adolescents Impacted by Family Violence and Trauma

There are times when our experiences as clinicians, practitioners, and managers align in a moment of enlightenment. This happened for one of us (Pond) several months ago at a meeting of foster parents who have been trained to provide intensive support to particularly vulnerable youth. In my welcoming remarks, I reflected upon some of the challenges associated with working with children whose lives have been impacted by multiple and chronic or recurrent interpersonal trauma, violence and neglect, experiences often referred to collectively as “complex trauma” (see Cook et al. 2005; Spinazzola et al. 2005; Spinazzola et al. 2013). I noted that residential programs see the same population of traumatized youth—often sharing cases and transition plans. We know from consistent federal data that in excess of 100,000 U.S. children and adolescents newly enter out-of-home placements each year (U.S. Department of Health and Human Services 2012). In some instances the determination of whether to place a maltreated child with a foster family versus within a congregate is based upon the acuity or severity of emotional and behavioral difficulties exhibited by these highly vulnerable youth. For example, through analysis of one of the world’s largest child trauma databases, our colleagues at National Center for Child Traumatic Stress (NCCTS) have demonstrated that youth in residential treatment settings constitute the most vulnerable subgroup of children and adolescents victimized by trauma, exhibiting the highest rates of trauma exposure, associated impairment, and need for extensive intervention (Briggs et al. 2012). Just as often, however, out-of-home placement decisions are seemingly “the luck of the draw,” predicated upon local resources and capacity, and in many instances ultimately decided bywhoever happens to be next in line for an available bed. Later during this meeting we had a guest speaker, Hector, a man now in his mid-thirties, who spoke about his life as one of these children who spent years in out-of-home placements. His story is all too common, although his level of insight about the impact of his experiences was exceptional. Hector approached me after the event, and told me that when I spoke about the impact of repeated, familial trauma—physical abuse, witnessing domestic violence, and chronic disruption of placements—“You are talking about me. That’s my story.” Sadly, this disclosure was hardly surprising considering recent research by our NCCTS colleagues establishing that over 70 % of children in foster care have been exposed to complex trauma (see Greeson et al. 2011). Through his entire childhood, Hector witnessed severe domestic violence and suffered frequent physical abuse. The violence escalated; his mother began to beat him to the point that he feared for his life. Even though he had barely turned 13, Hector had the bravery to walk into a social services office and ask that he be put into a safe place. Hector thought this act would be his salvation—what he knew of foster families was from television, and he thought what hewould find would be a family, or other caregivers that would help him and keep him safe. Instead, he experienced further disconnection and continuing loss. For the next 3 years, he was “bounced” from setting to setting, by his count nearly twenty (20) times. He went to nine different high schools. By his account, he was moved nomatter how he behaved. In his mind, if he was good, that was progress, and he was moved on. If he was “bad” he was not making progress, and was moved on. He described himself at 15 as hopeless, and alienated, and angry. Then, just as he turned 16, he met a family trained to provide more intensive support that demonstrated, through A. Pond Justice Resource Institute, Needham, MA, USA

Weapon Use Increases the Severity of Domestic Violence but Neither Weapon Use nor Firearm Access Increases the Risk or Severity of Recidivism

Use of weapons is a risk factor for domestic violence severity, especially lethality. It is not clear, however, whether access to firearms itself increases assault severity, or whether it is characteristic of a subgroup of offenders who are more likely to commit severe and repeated domestic assault. This reanalysis of 1,421 police reports of domestic violence by men found that 6% used a weapon during the assault and 8% had access to firearms. We expected that firearm use would be rare compared to other weapons and that actual weapon use rather than firearm access would increase the severity of domestic assaults. Firearm access was associated with assault severity, but this was mostly attributable to use of nonfirearm weapons. Weapon use was associated with older age, lower education, and relationship history as well as to assault severity. Victims were most concerned about future assaults following threats and actual injuries. Although firearm access and weapon use were related to actuarial risk of domestic violence recidivism, neither predicted the occurrence or severity of recidivism. We conclude that, consistent with previous research in the United States and Canada, firearm use in domestic violence is uncommon even among offenders with known firearm access. Weapon use is characteristic of a subgroup of offenders who commit more severe domestic violence, and seizure of weapons may be an effective intervention.

Association between gap in spousal education and domestic violence in India and Bangladesh

BackgroundDomestic violence (DV) against women is a serious human rights abuse and well recognised global public health concern. The occurrence of DV is negatively associated with the educational level of spouses but studies dealing with educational discrepancies of spouses show contradicting results: Wives with higher education than their husbands were more likely to ever experience DV as compared to equally educated couples. The purpose of this study was to investigate the association between spousal education gap (SEG) and the prevalence and severity of DV in India and Bangladesh.MethodsNationally representative data collected through the 2005/2006 Indian National Family Health Survey (NFHS-3) and 2007 Bangladesh Demographic and Health Survey (BDHS) were used. In total, we analysed data of 69,805 women aged 15–49 years (Bangladesh: 4,195 women, India: 65,610 women). In addition to univariate and bivariable analyses, a multinomial logistic regression model was used to quantify the association between education gap and less severe as well as severe domestic violence. Adjustment was made for age, religion, and family structure.ResultsWives with higher education than their husbands were less likely to experience less severe (OR = 0.83, 95% CI: 0.77–0.89) and severe (OR = 0.79, 95% CI: 0.72–0.87) DV as compared to equally low-educated spouses (reference group). Equally high-educated couples revealed the lowest likelihood of experiencing DV (severe violence: OR 0.43, CI 0.39–0.48; less severe violence: OR 0.59, CI 0.55–0.63). The model’s goodness of fit was low (Nagelkerke’s R2 = 0.152).ConclusionsOur analysis revealed no increased DV among wives with a higher educational level than their husbands. Moreover, the results point towards a decrease of severe violence with an increase in education levels among spouses. However, the model did not explain a satisfying amount of DV. Therefore, further research should be done to reveal unknown determinants so that suitable interventions to reduce DV can be developed.

Witnessing and experiencing domestic violence: a descriptive study of adolescents

The aim of the study was to describe the experiences of different types of domestic violence among adolescents and associations between the family background and different types of domestic violence. The survey included 1393 ninth-graders from one Finnish municipality. Domestic violence is fairly common in the lives of adolescents. Sixty-seven percent of respondents had experienced parental symbolic aggression, 55% mild violence and 9% severe violence during their childhood. Twelve percent of adolescents had witnessed parent-to-parent violence. Witnessing domestic violence and exposure to parental violence is associated with a number of adolescents' background factors such as self-perceived health, satisfaction with life, family relationships, parenting practice, school bullying and sexual activity. The findings stress the relevance of corporal punishment and witnessing domestic violence as a risk factor for more severe domestic violence and sexual abuse. Different types of domestic violence have a major effect on adolescent well-being and risk behaviours. To break the negative cycle, nurses and other professionals working with adolescents in different settings should pay attention to all forms of violence, including the milder ones.

Challenges of welfare-to-work programs

Governmental expectations of placement outcomes were often high given the severity of work barriers that were present in disabled welfare recipients in the United States [11]. The purpose of this article is to identify challenges that were inherent in welfare-to-work programs and solutions to these challenges. Although rich with opportunity, welfare-to-work programs presented the challenge of employing large numbers of difficult-to-employ individuals before their public assistance benefits expired\cite{5}. Many clients also had symptoms of Posttraumatic Stress Disorder (PTSD) secondary to childhood physical or sexual abuse (59%) or severe domestic violence (55%) [8]. Few funds were available for work training and education. Instead, the employment-first model was expected even though most consumers did not have a high school diploma, had not worked in years, and were fearful and resistant about returning to work [3]. Performance based payment systems presented a challenge because the program's future depended on the compliance of its consumers. There was an impetus for substance abusers to return to work even if they were still using drugs, which contradicted the teachings of many recovery models. This paper presents possible solutions to each of these problems and reports outcomes of one particular welfare-to-work program. By examining the challenges of welfare-to-work programs, by identifying solutions, and by realizing that these solutions are inherent in the basic principles of rehabilitation, this article provides therapists with tools and motivation to make unique contributions to this area of practice.