Supporting children exposed to domestic violence: call for stronger evidence base

Services for children who are exposed to domestic violence and abuse are vital, but NIHR-funded researchers have found that there is little evidence for what support works best. While there is much good quality evidence for the support offered to adult survivors of domestic abuse, there is very little evidence for what might help children from these families.

Children living in a home where there is domestic violence, even if they don’t directly witness violent acts, are more likely to suffer problematic behaviour, anxiety, depression, post-traumatic stress disorder, and educational problems. When they grow up, they are more likely to have mental health problems, to be unemployed, and to perpetrate or experience domestic violence than people who aren’t exposed to domestic violence as children.

There are support programmes for these children, or children and their non-abusing parent, that can improve the child’s behaviour and mental health in the short term. Some of these programmes have been tested in rigorous research studies, mostly conducted in North America, but many haven’t. Although the UK already has a number of programmes for children exposed to domestic violence, it’s not clear whether they are working as they haven’t been properly evaluated.

Researchers from the Universities of Bristol, Cambridge, Central Lancashire and Canada’s McMaster University, have examined all the existing studies on this issue, as well as interviewing parents, children and professionals in the field. Their report, IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis, was published in the NIHR Journal Public Health Research on 9 December.

They recommend that there should be many more in-depth studies in the UK to understand which programmes work, and which don’t. They also recommend that the programmes’ effectiveness should be measured against outcomes that children, parents, service providers and policymakers think are important, rather than researchers’ priorities.

The team, led by Dr Emma Howarth from the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England and Professor Gene Feder, from the Centre for Academic Primary Care, University of Bristol, identified three different types of programme that they recommend are prioritised for further research in the UK. These are:

• group based ‘psychoeducation’, where children (with or without their non-abusive parent) discuss and learn more about their situation and the effect it has on their mental health, with the help of a trained professional
• parenting training combined with ‘advocacy’ for parents, where they are given practical support by a professional to understand their options and rights, as well as to explore their reactions to their situation
• programmes with a ‘whole family’ approach, where the perpetrators of domestic violence are also involved

The team recommend that priority is given to studies focusing on the complex environments in which these interventions are delivered. Rather than a ‘one size fits all’ approach, tailored services for different groups of children and young people should be explored. And professionals in the field must agree a standard way of measuring success and ‘outcomes’ for children in these services. The team are also calling for a pause in developing new interventions, unless they meet a clear gap in services, and for the systematic evaluation of existing programmes.

The team are calling for the stakeholders in this field, including funders, researchers, commissioners and service providers, as well as the children and parents themselves, to come together to address the barriers that have hampered the development of the UK evidence base.

The research was funded by the NIHR Public Health Research Programme, with support from the NIHR CLAHRC East of England and CLAHRC West.

Dr Emma Howarth, who worked on the project while at the University of Bristol and then NIHR CLAHRC East of England, said:

“More research into how best to support these children is needed urgently. Children exposed to domestic abuse are very vulnerable. They are more likely to grow up with mental health problems and not achieve their full potential as a result. Some of the support programmes that the various studies looked at show promise, but without more in-depth, UK focused research, we can’t be sure that services are supporting these children in the best ways possible.”

The University of Bristol’s Professor Gene Feder, a leading researcher in the field of domestic violence and abuse, said:

“We already knew that there wasn’t much evidence for what support should be offered to children exposed to domestic abuse, but our research has revealed just how scant that evidence is. There have been no major studies in the UK, only service evaluations.

“Internationally, there is increasing emphasis on reducing the mental health impact of adverse events in childhood, including domestic abuse, through early intervention. However, the funding cuts we’ve seen in the UK over the last five years mean that many children are not being helped. And when programmes exist, we don’t know which programmes are the most effective in improving outcomes for which children.”

Paper

IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis
Emma Howarth, Theresa Moore, Nicky J Welton, Natalia Lewis, Nicky Stanley, Harriet MacMillan, Alison Shaw, Marianne Hester, Peter Bryden and Gene Feder