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

• DOI: 10.3310/phr04100
• Publication Date: 2016-12-09T11:05:13Z
• Authors: Emma Howarth; Theresa HM Moore; Nicky J Welton; Natalia Lewis; Nicky Stanley; Harriet MacMillan; Alison Shaw; Marianne Hester; Peter Bryden; Gene Feder
• Keywords: Psychoeducation

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