Mediators and Moderators of Change in Adjustment Following Intervention for Children Exposed to Intimate Partner Violence

Graham‐Bermann, Sandra A.; Howell, Kathryn H.; Lilly, Michelle M.; DeVoe, Ellen R.

doi:10.1177/0886260510372931

Cited by 45 publications

(58 citation statements)

References 30 publications

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“…44,52,248,249 This proposition requires further investigation in well-conducted trials to determine whether one intervention is more effective than another for reducing particular problems, and whether or not the effectiveness of an intervention differs depending on who receives it. Only a few studies looked at the moderators of treatment effects, 103,113,116 therefore there is also a need to explore other factors such as age and sex, culture and ethnicity of children and parents, children's exposure to other forms of trauma and adversity, and readiness to engage in the therapeutic process as factors that may moderate treatment outcomes.…”

Section: Synthesis Of Study Findingsmentioning

confidence: 99%

“…Two studies considered whether or not the severity and length of children's exposure to DVA moderated treatment effects, finding no effect, or bigger gains for children with relatively longer histories of exposure. 103,116 However, none of the studies analysed whether or not exposure to subsequent abuse (during the course of intervention) moderated treatment outcomes. Therefore, without direct evidence to the contrary, practitioners may continue to assume that the intervention is neither acceptable nor beneficial for this group of children.…”

Section: Ongoing Abusementioning

confidence: 99%

“…As we note above, most studies sampled children aged 4-14 years, with little focus on the age appropriateness and potential impact of interventions for children of different age groups (see Graham-Bermann et al 103 for an exception). However, consultation with young people highlighted age as an important determinant of the acceptability of interventions that require parental involvement, as well as the acceptability of different settings in which an intervention can be delivered.…”

Section: Age Of Childrenmentioning

confidence: 99%

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IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis

et al. 2016

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BackgroundExposure to domestic violence and abuse (DVA) during childhood and adolescence increases the risk of negative outcomes across the lifespan.ObjectivesTo synthesise evidence on the clinical effectiveness, cost-effectiveness and acceptability of interventions for children exposed to DVA, with the aim of making recommendations for further research.Design(1) A systematic review of controlled trials of interventions; (2) a systematic review of qualitative studies of participant and professional experience of interventions; (3) a network meta-analysis (NMA) of controlled trials and cost-effectiveness analysis; (4) an overview of current UK provision of interventions; and (5) consultations with young people, parents, service providers and commissioners.SettingsNorth America (11), the Netherlands (1) and Israel (1) for the systematic review of controlled trials of interventions; the USA (4) and the UK (1) for the systematic review of qualitative studies of participant and professional experience of interventions; and the UK for the overview of current UK provision of interventions and consultations with young people, parents, service providers and commissioners.ParticipantsA total of 1345 children for the systematic review of controlled trials of interventions; 100 children, 202 parents and 39 professionals for the systematic review of qualitative studies of participant and professional experience of interventions; and 16 young people, six parents and 20 service providers and commissioners for the consultation with young people, parents, service providers and commissioners.InterventionsPsychotherapeutic, advocacy, parenting skills and advocacy, psychoeducation, psychoeducation and advocacy, guided self-help.Main outcome measuresInternalising symptoms and externalising behaviour, mood, depression symptoms and diagnosis, post-traumatic stress disorder symptoms and self-esteem for the systematic review of controlled trials of interventions and NMA; views about and experience of interventions for the systematic review of qualitative studies of participant and professional experience of interventions and consultations.Data sourcesMEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, EMBASE, Cochrane Central Register of Controlled Trials, Science Citation Index, Applied Social Sciences Index and Abstracts, International Bibliography of the Social Sciences, Social Services Abstracts, Social Care Online, Sociological Abstracts, Social Science Citation Index, World Health Organization trials portal and clinicaltrials.gov.Review methodsA narrative review; a NMA and incremental cost-effectiveness analysis; and a qualitative synthesis.ResultsThe evidence base on targeted interventions was small, with limited settings and types of interventions; children were mostly < 14 years of age, and there was an absence of comparative studies. The interventions evaluated in trials were mostly psychotherapeutic and psychoeducational interventions delivered to the non-abusive parent and child, usually based on the child’s exposure to DVA (not specific clinical or broader social needs). Qualitative studies largely focused on psychoeducational interventions, some of which included the abusive parent. The evidence for clinical effectiveness was as follows: 11 trials reported improvements in behavioural or mental health outcomes, with modest effect sizes but significant heterogeneity and high or unclear risk of bias. Psychoeducational group-based interventions delivered to the child were found to be more effective for improving mental health outcomes than other types of intervention. Interventions delivered to (non-abusive) parents and to children were most likely to be effective for improving behavioural outcomes. However, there is a large degree of uncertainty around comparisons, particularly with regard to mental health outcomes. In terms of evidence of cost-effectiveness, there were no economic studies of interventions. Cost-effectiveness was modelled on the basis of the NMA, estimating differences between types of interventions. The outcomes measured in trials were largely confined to children’s mental health and behavioural symptoms and disorders, although stakeholders’ concepts of success were broader, suggesting that a broader range of outcomes should be measured in trials. Group-based psychoeducational interventions delivered to children and non-abusive parents in parallel were largely acceptable to all stakeholders. There is limited evidence for the acceptability of other types of intervention. In terms of the UK evidence base and service delivery landscape, there were no UK-based trials, few qualitative studies and little widespread service evaluation. Most programmes are group-based psychoeducational interventions. However, the funding crisis in the DVA sector is significantly undermining programme delivery.ConclusionsThe evidence base regarding the acceptability, clinical effectiveness and cost-effectiveness of interventions to improve outcomes for children exposed to DVA is underdeveloped. There is an urgent need for more high-quality studies, particularly trials, that are designed to produce actionable, generalisable findings that can be implemented in real-world settings and that can inform decisions about which interventions to commission and scale. We suggest that there is a need to pause the development of new interventions and to focus on the systematic evaluation of existing programmes. With regard to the UK, we have identified three types of programme that could be justifiably prioritised for further study: psycho-education delivered to mothers and children, or children alone; parent skills training in combination with advocacy: and interventions involving the abusive parent/caregiver. We also suggest that there is need for key stakeholders to come together to explicitly identify and address the structural, practical and cultural barriers that may have hampered the development of the UK evidence base to date.Future work recommendationsThere is a need for well-designed, well-conducted and well-reported UK-based randomised controlled trials with cost-effectiveness analyses and nested qualitative studies. Development of consensus in the field about core outcome data sets is required. There is a need for further exploration of the acceptability and effectiveness of interventions for specific groups of children and young people (i.e. based on ethnicity, age, trauma exposure and clinical profile). There is also a need for an investigation of the context in which interventions are delivered, including organisational setting and the broader community context, and the evaluation of qualities, qualifications and disciplines of personnel delivering interventions. We recommend prioritisation of psychoeducational interventions and parent skills training delivered in combination with advocacy in the next phase of trials, and exploratory trials of interventions that engage both the abusive and the non-abusive parent.Study registrationThis study is registered as PROSPERO CRD42013004348 and PROSPERO CRD420130043489.FundingThe National Institute for Health Research Public Health Research programme.

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Section: Synthesis Of Study Findingsmentioning

confidence: 99%

Section: Ongoing Abusementioning

confidence: 99%

Section: Age Of Childrenmentioning

confidence: 99%

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IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis

et al. 2016

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“…improve coping) and decrease risk factors and negative outcomes. CEV interventions with a specific caregiver component are developed in part on the theory that both parent behaviour and parent well-being are critical to the healthy development of their children (see Graham-Bermann, Howell, Lilly, & DeVoe, 2011). Caregiver interventions designed to increase protective factors and decrease risk factors are thought to improve outcomes for children by improving parent behaviour and well-being.…”

Section: Implications For Cev Interventionsmentioning

confidence: 99%

Do Maternal and Paternal Mental Illness and Substance Abuse Predict Treatment Outcomes for Children Exposed to Violence?

Risser

Messinger

Fry

et al. 2013

Child Care in Practice

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“…Numerosos trabajos señalan que aspectos tales como el funcionamiento positivo de la madre, la cohesión familiar y los servicios de apoyo actúan como factores protectores en el desarrollo psicosocial de los menores que han vivido expuestos a violencia de género (Anderson & Bang, 2012;Brodowsky and Fisxhmann, 2012;Graham-Bermann, Howell, Lilly, & DeVoe, 2011;Jouriles et al, 2009;Tajima et al, 2011). De ahí que, en el plano de la intervención, hace unas décadas empezaran a desarrollarse fuera de nuestras fronteras programas dirigidos a estos menores, orientados al tratamiento individual ante reacciones traumáticas (Groves, 1999;Silvern, Karyl y Landis, 1995) (2001) mostro que los nin os y nin as que participaron en programas grupales para menores expuestos a violencia dome stica o en programas de trabajo con la diada madre-hijo redujeron sus conductas agresivas y sus niveles de ansiedad y depresio n, y mejoraron sus relaciones tanto con la figura materna como con los iguales.…”

Section: Intervención Con Menores Víctimas De Violencia De Génerounclassified

Menores expuestos a violencia de género. Cambios legislativos, investigación y buenas prácticas en España

Limiñana¹

2017

Pap. Psicol.

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Children who live in contexts of Intimate partner violence (IPV) are also victims of this violence, whether they have witnessed it or they have been beaten themselves. The research has highlighted that exposure to IPV has significant repercussions on the psychosocial development of these children. This evidence demands the implementation of measures and programs aimed at intervening with them. The objective of this study is to assess the current situation of children exposed to IPV in

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Mediators and Moderators of Change in Adjustment Following Intervention for Children Exposed to Intimate Partner Violence

Cited by 45 publications

References 30 publications

IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis

IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis

Do Maternal and Paternal Mental Illness and Substance Abuse Predict Treatment Outcomes for Children Exposed to Violence?

Menores expuestos a violencia de género. Cambios legislativos, investigación y buenas prácticas en España

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