10 July 2018
Growing up in a household with domestic violence and abuse can affect children for the rest of their lives. Support programmes specifically aimed at children who have been exposed to abuse exist, but determining how and when parents and children are ready to engage with them is challenging. A review, carried out by researchers at the University of Bristol together with NIHR CLAHRC West, NIHR CLAHRC East of England and the University of Central Lancashire, sheds light on some of these factors.
The researchers looked at qualitative research on children’s and parents’ experiences of participating in these child-centred programmes, and professionals’ experiences of delivering them.
The research team found studies on programmes delivered after the domestic abuse had reduced or ended. Most programmes involved the abused parent and children, while others included the perpetrator of the abuse. Even in programmes where the abused parents’ direct involvement wasn’t necessary, they were usually responsible for managing their child’s access to and participation in such programmes.
The review found that whether a parent or child is ready to participate is influenced by a mix of factors. For parents to be ready to engage, they must first be aware of the impact domestic violence and abuse has on their children. They must be ready to shift their focus from their own needs to those of their children in the context of the abuse. This is very different from being ready to end an abusive relationship, which in itself is a significant undertaking.
Sometimes a child is ready to participate, but their parent isn’t. This research found that a child’s involvement in a programme is least likely when the parent, rather than the child, is unwilling to participate. A particular barrier to engagement was parental concerns about the repercussions of their children sharing information about the abuse they have experienced.
Participating in specialist programmes can heighten children’s awareness of abuse, which may lead to challenging behaviour and questions that are difficult for the parent to answer. As children process their experiences, they may ask questions like ‘why did you stay?’, which parents may not be ready to deal with. The researchers concluded that it’s vital that professionals fully inform participants about where confidentiality ends and professionals’ safeguarding duties begin. This will help to avoid a breakdown in the relationship between the professionals and the participants. However, professionals should be cautious when a parent is unable or unwilling to engage, as this may lead the parent to feel alienated and resist involvement altogether. In these circumstances, the researchers concluded, it may be better to work directly with parents to systematically address their barriers to engaging.
Specialist practitioners can help to prepare parents and children before they start a support programme. This allows the practitioners to address any practical barriers to attending, while preparing parents and children so they know what to expect.
Tess Moore, Senior Research Associate at NIHR CLAHRC West and a researcher on the project, said:
“This review shows just how challenging it is to get these child-centred programmes right, for both parents and children. It’s essential that children who’ve experienced domestic violence and abuse have access to these support programmes. This work shows that the parent’s readiness to participate is a key factor in whether an intervention can be successful or not. The work to build families’ willingness to participate begins long before they engage with interventions.”
Emma Howarth, Cambridge Institute of Public Health, University of Cambridge and lead researcher on the project, said:
“In strengthening the health care response to domestic violence and abuse, we need to meet the needs of children directly witnessing or otherwise exposed to this violence and abuse. Developing effective programmes to support these children must include working with families on their readiness to participate.”
Overall, this research highlights how different, interlinked processes lead to parents and children being ready to engage in an intervention aimed at improving the child’s outcomes. The findings of this study can help practitioners to better understand the factors that may help or hinder engagement so that they can provide effective support to increase access to specialist programmes.
Towards an ecological understanding of readiness to engage with interventions for children exposed to domestic violence and abuse: systematic review and qualitative synthesis of perspectives of children, parents and practitioners
Emma Howarth, Theresa HM Moore, Nicky Stanley, Harriet L MacMillan, Gene Feder, Alison Shaw
Published in Health and Social Care in the Community