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Abstract
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Background
The problem, condition or issue
Children and adolescent's1 exposure to intimate partner violence (IPV), or domestic violence, is a pervasive public health problem. An estimated 8 to 15 million children in the United States (Hamby, Finkelhor, Turner, & Ormrod, 2011; McDonald, Jouriles, Ramisetty-Mikler, Caetano, & Green, 2006) and 275 million children worldwide are exposed to IPV each year (Pinheiro, 2006). The consequences of exposure can be severe and long-lasting. Research has linked IPV exposure in childhood to impaired neurological, physiological, and psychosocial functioning that contribute to a wide-range of health consequences. Indeed, IPV exposure has been associated with reduced cognitive ability and educational achievement (Kitzmann et al., 2003), under-immunization (Bair-Merritt, Blackstone, & Feudtner, 2008), and both psychological (e.g., posttraumatic stress, depression, aggression; Davies, Evans, & DiLillo, 2008) and physical health problems (e.g., ischemic heart disease, obesity; Felitti et al., 1998). These negative developmental sequalae appear to be evident across nations and cultures; for example, the link between IPV exposure and future physical and/or sexual victimization has been found in studies conducted in the United States, China, South Africa, Colombia, India, Egypt, the Philippines, and Mexico; see Runyan, Wattam, Ikeda, Hassan, & Ramiro, 2002).
Documentation of the immense magnitude and burden of children's exposure to IPV has been met with an increased interest in the development of intervention strategies to protect this vulnerable population and promote well-being. Interventions for children exposed to IPV were initially developed in the late 1980s and 1990s and predominately focused on provision of general support; they were available only in battered women's shelters or from agencies providing services to victimized women (see Graham-Bermann & Hughes, 2003 for a review of early programming). More recently, theory-driven psychosocial programs serving children exposed to violence have been developed and established in other venues (e.g., school-based mental health clinics, outpatient psychotherapy settings). A recent scan identified 23 unique programs designed to improve outcomes for children exposed to IPV currently being implemented across the United States, with at least 8 of these programs having been subject to one or more rigorous evaluations, including randomized controlled trials (Chamberlain, 2014). To date, however, no systematic review has been conducted to synthesize the state of this burgeoning literature and provide recommendations for research and practice.
The intervention
Our review is focused on psychosocial interventions where the primary or secondary aim is the promotion of child well-being following exposure to IPV. Psychosocial interventions are defined broadly to include a wide variety of services that emphasize psychological and/or social factors rather than biological factors. Interventions may be psychological in nature, such as psychotherapies of various orientations (e.g., cognitive-behavioural or interpersonal therapy) and/or social in nature (e.g., peer support services) (England et al., 2015). Importantly, interventions must involve provision of psychosocial services to the exposed child, the exposed child plus a caregiver(s), or only a caregiver(s). Studies must include outcome data on at least one child outcome to be included. Studies that report only caregiver outcomes will be excluded.
Interventions can occur in any setting, provided they include a psychological and/or social component; including but not limited to domestic violence shelters or service organizations, schools, outpatient clinics, criminal justice settings, or hospitals. The treatment modalities vary, including individual, family, or group-based treatment. Below we provide example interventions in each of these categories.
Individual intervention. One-on-one treatment permits attention to individualized traumatic cues, distorted thoughts, and behavioral interactions. For example, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT; Cohen, Mannarino, & Deblinger, 2006) is a clinic-based intervention - rooted in learning and cognitive theories--addresses distorted beliefs and attributions related to the traumatic experiences and provides a supportive environment in which the child can talk about the traumatic experience or abuse. The treatment focuses on individual therapy sessions with children ages 3 to 18 years with parallel parent sessions that focus on the same elements as their child. Often, joint parent-child sessions are also conducted. TF-CBT is typically 12 to 16 sessions in length, although it has been modified into a shorter version for delivery in domestic violence shelters (Cohen, Mannarino, & Iyengar, 2011).
Family-based intervention. Family-based interventions, such as Child-Parent Psychotherapy (CPP; Lieberman, 2004) involve sessions with a caregiver and a child age 0 to 5 years - with the dyad as the unit of treatment. CPP focuses on the focusing on the child-mother relationship as the therapeutic mechanism of change and usually delivered by therapists in 12 to 40 hour-long sessions. Whereas CPP was designed to address exposure to trauma broadly defined, Project Support (Jouriles, McDonald, Rosenfield, Stephens, Corbitt-Shindler, & Miller, 2009) was developed specifically for mothers and their children, age 4 to 9 years, with a history of IPV exposure. This family-based intervention is delivered by a therapist in the mother's home and focuses on increasing the mother's problem solving and behaviour management skills. Project Support is typically involves 20 home visits over a six month period.
Group intervention. Group interventions, which typically are administered in schools, community settings, and domestic violence shelters, target general beliefs and attitudes about violence, reactions to violence, and social problem solving skills. For example, Kids' Club and Mom's Empowerment Program (MEP) (Graham-Berman, 2000; Graham-Bermann, Lynch, Banyard, DeVoe, & Halabu, 2007) are two group-based psychosocial programs delivered in a broad range of settings (e.g., community-based agency, outpatient mental health clinic). Kids' Club is designed for children age 6 to 12 years and creates a safe space for children to identify and express emotions and build social, emotional and coping skills. Moms Empowerment is a 10-session parenting group that provides support to mothers of children age 6 to 12 years by empowering them to discuss the impact of the violence on their child's development and to build parenting competence.
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Language: en |