When are children and parents who have experienced domestic abuse ready to engage with child-centred support programmes?
11 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.
Professor Gene Feder, from the Centre for Academic Primary Care, University of Bristol and senior researcher on the study, said:
"For any health, psychological or social care intervention to succeed, we need to know what might help or hinder participation. This review demonstrates how important it is to understand the perspectives of both children exposed to domestic violence and their parents, as their readiness to engage with an intervention may emerge at different times. New programmes for children exposed to domestic violence and abuse should have a preparatory period to promote and support a family's readiness to engage."
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. July 2018.
About the Centre for Academic Primary Care
The Centre for Academic Primary Care (CAPC) at the University of Bristol is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching. Follow us on Twitter: @capcbristol.
About the National Institute for Health Research
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