What is this?

• Intimate partner violence is defined as a behavior by an intimate partner that causes physical, sexual and psychological harm (World Health Organization, 2017). Women are the most exposed to intimate partner violence and as primary caregivers, their experiences are likely to directly impact children through direct negative effect and adverse effect on the child and their parenting skills (Anderson and van E, 2019). However, it is not clear which social care program can deliver good outcomes for the mother and their children. Evidence on the theory of change through which it occurs and its interactions with contextual factors are not clear.
• The Child-Parent Psychotherapy consists of weekly sessions between parent and child led by a trained therapist with individual sessions between the parent and the therapist as well as case management plus community referral for individuals both allocated randomly (Lieberman et al., 2005; 2006). The intervention is aimed at fostering positive interactions between the mother and child and creating the opportunity for a narrative to develop between them regarding the trauma experienced.
• The Project Support program is based on two distinct areas of provision: the teaching of child management skills, and the provision of practical and emotional support to mothers (McDonald et al., 2006).

How is it meant to work?

• The common features of these interventions are the provision of social support, an aim to improve the child-mother relationships and training to include problem solving skills and parenting knowledge (Austin et al., 2017). Interventions differ slightly in terms of the mechanisms they used to achieve positive outcomes.
• The theory of change (Anderson and van E., 2019) is based on two types of mechanisms. The first mechanism, named as individualistic, is based on simultaneous but independent sessions for the mother and the child. These sessions allow both to explore their own personal experience and exposure to the violent partner. These often include psychological and educational approaches to possible harmful coping mechanisms of the child.
• The second mechanisms take advantage of the child’s agency and the child-mother relationship. Additional collaborative sessions supplement the individual ones and allows the child and mothers to share their experiences, articulate their feelings and work together shaping better outcomes for both.

What are the evaluated outcomes?

• Maternal Distress
• Parenting Skills

How effective is it?

Overall, Interventions for Women Parenting in the Context of Intimate Partner Violence had a mixed effect on Maternal Distress and Parenting Skills. This is based on a moderate strength of evidence.

In Child-Parent Psychotherapy, the findings revealed a decrease in maternal distress for the group who received the Child-Parent Psychotherapy program but not for the group who received the in-case management program (Lieberman et al., 2005). Those results are based on one Randomised Controlled Trial (RCT) conducted in the United States which includes 65 mothers and their child. Parenting skills are also improved, as evaluated by mother’s attitudes to child rearing in between the third trimester of pregnancy to 6 months after giving birth (Lavi et al. (2015). However this finding is less reliable as it is based on an observational study.

Studies evaluating Project Support found no significant difference between the intervention and the control group in terms of maternal distress. (Jouriles et al., 2001, McDonald et al., 2006). However, while psychiatric and trauma symptoms reduce for both control and treated group, reduction on the longer term is only observed for the treatment group (Jouriles et al., 2009), highlighting a likely long term impact of Project Support. In terms of parenting skills, the group which received the Project Support home visit increased significantly their child management skills (Jouriles et al., 2001; McDonald et al., 2006). However, results vary depending on the definition of parenting skills. Findings are based on two Randomised Controlled Trials (RCTs) in the United States, with a sample size varying between 36 and 65.

Where has it been studied?

• The effectiveness ratings are based on studies conducted in the United States.
• The mechanisms reported here are primarily based on studies in the United States (14) with one example of a study in Israel, one in Canada and one in Wales.

Who does it work for?

Interventions were targeted at women in the context of parenting with intimate partner violence. The mean age of women in the studies was 28. The studies reported ethical diversity but no details of the outcomes per ethnic group are provided. Children in the studies were typically aged between four and nine years old.

When, where and how does it work?

• Interventions seem to work better over a longer period of time (Lieberman et al., 2006).  The interventions often focussed on using social support from the families’ community. Some suggest that more vulnerable families with less connections might not have had access to these programs and thus, a selection bias might appear in the sample (McDonald et al., 2006).
• In addition, contextual factors may substantially impact program outcomes. Indeed, a range of barriers could potentially limit the access to the program. Individual differences such as maternal mental health or financial difficulties, socio economic barriers such as a lack of support or resources in the community as well as precarious employment and limited affordable housing availability will directly limit the access of those programs. Those are particularly important for the Child Parent Psychotherapy as it required a one year commitment (Lieberman et al., 2006).

What are the costs and benefits?

No economic analysis was included in either study.

Case study

• Domestic Abuse, Recovering Together (DART™) has been delivered in Foyle, Northern Ireland by the NSPCC.
• The intervention consists of a weekly 2 hours group session with the mother and children over a period of 10 weeks. Children and mothers work together for an hour and then take part in activities in separate group to join together at the end
• Women learn about the process of domestic abuse and the way it affects their children. They also learn about experiences and strategies useful for parenting. Children develop their understanding of domestic abuse and learn to express their feelings and how to be safe.
• Results suggest positive outcomes for mothers self-esteem and confidence in their parenting abilities, as well as fewer emotional and behavioral difficulties for children. Children appeared to be experiencing significantly fewer emotional and behavioral difficulties following DART. However, DART has only been evaluated through a non randomised study (Smith, 2016) but included in the meta analysis.

In summary...

• Child-Parent Psychotherapy significantly decreased maternal distress over and after the six months after the intervention but findings on women’s attitudes to parenting improvement are limited.
• Project Support achieved no significant differences for maternal distress for women immediately after the intervention but psychiatric and trauma symptoms continued to decrease for women 24 months after the intervention. This intervention was also associated with significantly higher child management skills immediately after the intervention and at 24 months follow up.
• Results are promising for interventions that include individual and combined sessions for mothers and children and which focused on enhancing the mother-child relationship and further research is needed.
• Research is spread across a wide variety of programs which makes it difficult to reach precise and definitive conclusions. More research is needed into the effectiveness of different interventions and the theory of change underlying the interventions.