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Een kennisparel van Jaap de Waard

[20] 10 april 2020: The promotion of well‐being among children exposed to intimate partner violence: A systematic review of interventions

Vandaag Goede Vrijdag en, zoals jullie inmiddels verwachten, de ontvangst van een zogenaamde ´kennisparel´. Nummer 20 alweer, deze gaat over interventies gericht op kinderen die geconfronteerd zijn geweest met geweld binnen het gezin. Huiselijk geweld staat op dit moment volop in het nieuws. Vanwege het COVID-19 virus hebben veel overheden de verplichting ingesteld om inwoners zo veel mogelijk binnen het eigen huis te laten verblijven. De eerste geluiden die nu naar buiten komen is dat er sprake is van een toename van geweld ´achter de voordeur´. In hoeverre er daadwerkelijk sprake is van een toename is van huiselijk geweld is op dit moment nog onduidelijk. Wel pleitte United Nations´ grote baas, António Guterres op 6 april jl. al om alle zeilen bij te zetten om de toename van huiselijk geweld vanwege het COVID-19 virus tegen te gaan: https://news.un.org/en/story/2020/04/1061052

De bijgesloten onderzoeksynthese geeft een oordeel over de mate van effectiviteit van interventies gericht op het verwerken van de nadelige gevolgen (soms trauma´s) bij kinderen die getuige zijn geweest van vormen van huiselijk geweld. Hopelijk om van te leren.     

Bron

Latzman, Natasha E., Cecilia Casanueva, Julia Brinton, & Valerie L. Forman‐Hoffman (2019). The promotion of well‐being among children exposed to intimate partner violence: A systematic review of interventions. Campbell Systematic Reviews, vol. 15, September, pp. 1-50. https://onlinelibrary.wiley.com/doi/10.1002/cl2.1049

Introduction

Children’s exposure to intimate partner violence (IPV) is a significant public health and social justice concern with potentially severe and long‐lasting effects. The extent to which psychosocial interventions promote well‐being among children exposed to IPV, and under what circumstances, such as the modality and setting, is unclear.

What is this review about?

Exposure to IPV childhood can have both short‐ and long‐term negative impacts to health and well‐being that persist across generations. There is therefore an increased interest in the development of intervention strategies to promote well‐being following exposure. Over the last two decades, theory‐driven psychosocial programs serving children exposed to violence have been developed and established in a range of venues (e.g., school‐based mental health clinics, outpatient psychotherapy settings). This review provides a synthesis of the state of this literature and implications for research and practice. Specifically, we assess the effectiveness of psychosocial interventions in improving total problems, externalizing distress, internalizing distress, interpersonal/social problems, and cognitive functioning. We also consider variation in effects by intervention modality (e.g., individual, family‐based) and setting of the intervention (e.g., home, outpatient clinic). This Campbell systematic review examines the effects of psychosocial interventions to promote well‐being among children exposed to intimate partner violence. The review summarizes evidence from eight methodologically rigorous randomized controlled trials.

What studies are included in this review?

This review includes eight randomized controlled trials (RCTs), with a total of 924 participants. The majority of studies were conducted in the United States, with one study each carried out in the Netherlands and India. The age range of target children varied, although all fell within the age range of 0–18 years. Three studies recruited general populations of parents and/or children who had been exposed to IPV, without stated inclusion criteria around parent or child symptomatology or functioning. Four studies had more explicit inclusion requirements such as children with IPV‐related posttraumatic stress disorder (PTSD) symptoms and fathers with alcohol dependence. Studies varied widely regarding the nature of IPV experienced by parents and witnessed or heard by children.

What are the main findings of this review?

Studies examined following outcomes: total problems, externalizing distress, internalizing distress, interpersonal/social problems, and cognitive functioning. However, differences in the specific measures used, interventions employed, and comparison groups limit the ability to synthesize findings. Evidence from 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 post treatment and at an 8‐month follow‐up, but not at a 4‐month follow‐up. Intervention targeting the no offending parent (mother) had the largest effect, followed by those that targeted the family together and, finally, the single study that targeted parent and child, separately. Interventions conducted in the home had a larger effect 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. Overall, it is largely unclear the extent to which psychosocial interventions promote well‐being among children exposed to IPV, and under what circumstances.

What do the findings of this review mean?

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. More rigorous evaluation of psychosocial interventions need to be conducted using common outcomes across studies in order to draw conclusions. We suggest that in addition to increased rigor in evaluation design (such as efforts to minimize selection bias), researchers assess the nature of child exposure and multiple subtypes of IPV; this will help elucidate whether interventions are more or less effective depending on the IPV exposure context.

Het blijkt dus op basis van de bestaande kennis niet mogelijk om uitspraken te doen welke interventies, om het welzijn van kinderen die geconfronteerd zijn met huiselijk geweld, op een effectieve manier bevorderen. Daarom geldt ook hier de dooddoener die veel onderzoekers ons regelmatig mee geven: nader gedegen evaluatieonderzoek is gewenst.

Tot de volgende ´kennisparel´ maar weer! Blijf gezond en zorg goed voor elkaar, ook achter de voordeur.