Background
Children's exposure to IPV is a significant public health and social justice concern. The consequences of exposure can be severe and long‐lasting. 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. Over the last two decades, 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). This review provides a synthesis of the state of this burgeoning literature and recommendations for research. Specifically, we examined the impact of psychosocial interventions on well‐being among children exposed to IPV. Outcomes examined include overall child behavior, externalizing problems, internalizing problems. Also examined are intervention modality (e.g., individual, family‐based) and setting of the intervention (e.g., home, outpatient clinic).
Objectives
The objective of this review was to synthesize the evidence on the impact of psychosocial interventions on well‐being among children exposed to IPV.
Search methods
A combination of 10 databases and websites were searched. In addition to searching electronic resources, reference lists of relevant reviews (systematic and unsystematic) were scanned. Searches were executed by two reviewers and conducted between January and April 2018.Selection criteriaExperimental and quasiexperimental designs (with a comparison group) were eligible for inclusion. Included studies must have received a rating of low or moderate on a standardized risk of bias assessment. Additionally, studies must have examined child‐level outcomes (here defined as >75% of the sample between ages 0 and 17 years), regardless of the intervention target (e.g., child and/or parent). All child‐level outcomes were of interest; that is, specific outcomes were not used as criteria for inclusion in the review.
Data collection and analysis
Our search identified 1,049 unique titles, all of which underwent abstract screening. Of these, 200 titles were retrieved for closer analysis of the full‐text based on the information included in the title and abstract. Subsequently, 169 full‐text reports were excluded that did not meet inclusion criteria leaving 31 articles for which we completed a risk of bias assessment. Finally, 16 articles (across 11 independent studies) studies were excluded due to coder assessed high risk of bias. This left 15 publications across eight independent studies in our final sample.All included publications underwent systematic coding of study features. To examine the impact of interventions, all child‐level outcomes were converted into standardized effect sizes reflecting the direction and magnitude of intervention effects. If we found two or more similar studies for a comparison of interest, we conducted a meta‐analysis, under a random‐effect model, of the data from those studies. We report the impact of interventions using standardized differences of means, 95% confidence intervals (CIs), and respective forest plots. Subgroup analysis was conducted to examine the impact of characteristics (modality, setting) of interest. We assessed publication bias by constructing a funnel plot to display the precision versus effect sizes of each included study.
Results
We identified eight RCTs, with a total of 924 participants, reporting results on the impact of a range of interventions on well‐being among children exposed to IPV. Studies examined outcomes in the following domains: total problems, externalizing distress, internalizing distress, interpersonal/social problems, and cognitive functioning. However, the clinical and methodological heterogeneity of included studies largely precluded pooling of trials. Specifically, there was a high degree of heterogeneity with regard to differences in outcomes examined, interventions employed, and comparators (some studies employed a control group whereas others were comparative effectiveness studies that examined two active interventions).Meta‐analysis was only able to be conducted for one outcome, externalizing behaviors. Meta‐analysis of two studies suggests there is preliminary evidence that in‐home intensive services (parent training and provision of emotional support to the parent) decreases child externalizing behavior among children who have been exposed to IPV and have clinical levels of behavior problems. However, support for this evidence was only found immediately posttreatment and at an 8‐month follow‐up, but not at a 4‐month follow‐up.With regard to modality, pooled findings indicate that studies targeting the nonoffending parent (mother) had the highest pooled effect size, followed by those that targeted the family together and, finally, the single study that targeted parent and child, separately. With regard to setting, pooled findings indicated that studies conducted in the home had a larger pooled effect size as compared to those conducted in an outpatient setting. However, these findings should be interpreted with great caution due to the heterogeneity in study characteristics such as the nature of the comparators.All findings taken together, it is largely unclear the extent to which psychosocial interventions promote well‐being among children exposed to IPV, and under what circumstances.
Authors’ conclusions
The findings from this systematic review indicate that it is largely unclear the extent to which psychosocial interventions promote well‐being among children exposed to IPV, and under what circumstances. Given the inconclusive findings from our review, below we outline three general conclusions and recommendations for future research to build the evidence base. First, the evidence base remains underdeveloped and characterized by some breadth at the sake of depth. This breath became evident during our full‐text review and systematic application of inclusion and exclusion criteria. For example, 23 reports provided a program description or presented qualitative data only, and another 37 evaluated programs but failed to include a comparison group. This suggests there is great interest in developing, describing, and evaluating programs for children exposed to IPV. In addition, 20 reports were excluded because they did not present child‐level outcomes. Studies excluded for this reason typically examined outcomes at the level of the victimized parent. The addition of child‐level measures to parent‐focused evaluations would be a contribution to the evidence base and with relatively minimal resources. Finally, we found very few replication studies—our meta‐analyses of externalizing outcomes were in fact limited to a single replication study conducted by the same team as the original study. Paired with the fact that half of the studies in our review had fewer than 100 total participants, well‐powered replication studies conducted by independent research teams will undoubtedly help move the field forward.Second, although 19 independent studies met our full‐text review inclusion criteria, 11 of these studies were ultimately excluded due to high risk of bias. Again, this highlights the breadth of programming, but unfortunately, lack of internal validity of a large proportion of existing work. We recommend—particularly for programs with strong theoretical grounding and uptake in the field (e.g., Kids’ Club, Pre Kids’ Club and Mom's Empowerment Program [MEP])—more rigorous evaluation by independent research teams.Third, consistent with the larger literature, included studies generally failed to acknowledge the varied ways in which children come to know about their parent's IPV victimization (exposure) or consider the full range of the types of IPV to which children can be exposed. Future research should consider assessing the full range of ways in which children are exposed (direct involvement, direct eyewitness, indirect exposure) to multiple types of IPV (physical, sexual, and psychological aggression, and stalking).
Oversett med Google Translate
