Strengthening the mother-child relationship following domestic abuse
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Evaluation Findings Emma Smith 2015 BASPCAN presentation NSPCC
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Strengthening the mother-child relationship following domestic abuse
- 1. Strengthening the mother-child relationship following domestic abuse Evaluation findings Emma Smith 2015 BASPCAN presentation
- 2. Aims: - rebuild mother/child relationship - support other aspects of recovery Theory of change: - Child recovery from DA facilitated by non-abusing parent - Mother/child relationship may need strengthening to support this Innovative programme with: - Joint and separate sessions - 2.5 hour sessions for 10 weeks - Developed by Gwynne Rayns Domestic Abuse Recovering Together (DART)
- 3. Design: - Mixed methods. - Impact and process evaluation - Quasi-experimental - Small comparison group: Play therapy at refuge (n = 18) Methods: - before (T1), after (T2) and 6 months later (T3) - Surveys, interviews and standardised measures Participants: - Mothers, children, DART practitioners and referrers DART Evaluation: Methodology
- 4. Outcomes: -Improvements to self esteem, mother/child relationship, child’s behaviour, child well-being, mother’s parenting Measures: Rosenberg self esteem scale, SDQs, Parental acceptance and rejection questionnaires, Parental Locus of control scale Numbers: Mothers T1 = 158, T2 = 88 T3 = 22 Children T1 = 166, T2 = 96 T3 = 27 4 DART Evaluation: Methodology
- 5. Key improvements and statistical findings DART Mothers: - Greater self esteem - More confidence in parenting - Warmer and more affectionate to child - Fewer ‘rejecting’ parenting behaviours - Rated DART highly (4.8 out of 5) - Most improvements maintained at T3 DART Children - Fewer emotional and behavioural difficulties - Greater improvements than comparison group - Reported mother as warmer and more affectionate - Rated DART highly (4.7 out of 5) - Most improvements maintained at T3 5
- 6. Changes to mother’s clinical categories: 6 Informed consent Participant distressed Need identifie 7% 70% 38% 23% 62% 0% 20% 40% 60% 80% 100% Within normal range at T1 (n = 44) Below normal range at T1 (n = 37) Changes in mother's self-esteem categories Deteriorated Stayed the same Improved
- 7. Changes to children’s clinical categories: 7 Informed consent Participant distressed Need identifie 4% 7% 96% 21% 54.5% 71% 45.5% 0% 20% 40% 60% 80% 100% Low need Some need High need Changes in children's 'total difficulties' categories (SDQ) Deteriorated Stayed the same Improved
- 8. Joint sessions: - Bonding activities, tailored parenting advice, discuss abuse Creative activities: - Child-friendly, suitable for sensitive topics, considered fun, child able to illustrate experience of DA (very powerful) Skilled practitioners: - Open-minded, non-judgemental, safe environment created Separate sessions: - Peer support, experiences shared in more depth 8 What worked well? (key facilitators)
- 9. Initial lack of flexibility - Original manual ‘too prescriptive’ need to adapt to individual needs Contact with perpetrator - Could disrupt progress when child hears negative things about mother. Some mothers resumed abusive relationship. - Disruptive group members - Some overly dominant, inappropriate comments Mothers not ready for group work - anxious, overwhelmed, not ready to focus on child’s needs 9 What were the barriers?
- 10. Conclusions and next steps DART is an effective approach which supports mother/child recovery following DA Some families with higher levels of need may need additional support following the programme Mothers may benefit from pre-group sessions Adapted version of DART has been developed with pre-group work element. Evaluation of adapted approach 10
Editor's Notes
- Hi everyone etc. Today I will be describing an intervention called DART and reporting on the findings from the final evaluation report.
- So the DART intervention is for mothers and children who experienced domestic abuse but have left this situation and may be experiencing related difficulties which they need some support to recover from. What is relatively unique and innovative about this intervention is the focus on rebuilding the mother and child relationship- via joint sessions which is one of the key aims. This is based on research that suggests that children recover better from domestic abuse if they have their non-abusing parent helping to facilitate this. However, research also shows that the mother and child relationship can be damaged in a number of ways from the experience of domestic abuse, for example mothers may become depressed and have low self-esteem, which affects their resources to parent. Children may have seen their mother constantly undermined by their ex-partner and this can sometimes affect the respect they have for her. So DART has these joint sessions which involve both mothers and children in a group work setting where they work on a range of activities which aim to enable them to acknowledge the abuse and discuss related feelings and emotions. Often mothers have underestimated how their child has been affected by the abuse and understanding more about this can help them to be more supportive and understand the reasons when the child may behave negativley as a result..
- We used a mixed methods approach for the evaluation: we were looking to measure the impact of the intervention but also to look at the process- what aspects of the intervention seemed important in terms of achieving outcomes and what were the barriers. We collected standardised measures data at three time points: before after and six months after the intervention so we could look at the longer term affects of the intervention. We include a comparison group, which was a play therapy group at a domestic abuse refuge so that we could compare the outcomes of children from the DART group with children receiving a different intervention. The number of measures completed by mothers and children at each stage is shown at the bottom of the slide. As you can see- the numbers are quite low and this is a limitation. The comparison group also had low numbers so this is another limitation to bear in mind. We also conducted a series of interviews with a sample of mothers, children and DART practitioners. We also had end of programme surveys for the families so they could rate the service and also professionals who made referrals to the service were surveyed. The outcomes we were looking at included increased warmth between mother and child, improvements to self esteem, confidence in parenting and a reduction in the child’s emotional and behavioural difficulties. Some of the measures used are listed- they include widely used measures such as the Rosenberg self esteem scale and the strengths and difficulties questionnaire.
- This slide shows key findings from the statistical comparisons of the data. We compared the mother and children’s scores on the standardised measures before and after DART and there were a number of statistically significant improvement: The mothers had greater self esteem, had greater confidence in their parenting abilities, felt warmer and more affectionate towards their child and reported fewer rejecting behaviours on the parental acceptance and rejection questionnaire. The children also completed a version of the parental acceptance and rejection questionnaire and their reports also showed the same improvements- so gave more weight to their mother’s self-reports. Children had fewer emotional and behavioural difficulties after DART and also had greater reductions in their ‘difficulties’ scores than the comparison group. - Most of the improvements found before and after DART were maintained six months later. The improvements found from the parental acceptance and rejection and rejection questionnaire was no longer statistically significant however. Most parents had fairly good PARQ scores at T1 and were above or better than the normal range which may have made it harder to illustrate improvement.
- We also wanted to look at how things changed in terms of how mothers and children were categorised according to measures- for example on the Rosenberg self esteem scale the percentage that moved from having ‘low self esteem to having a score within the ‘normal range’. This was not possible for all the measures we used as some did not provide any categories or normal ranges. I have provided a couple of examples of the analyses we did when this was possible. This chart shows the changes for the mothers who were categorised as having low esteem, or self esteem within the normal range before DART. The bar at the top shows that 62% of mothers of those with low self esteem moved to within the normal range following DART but 38% still had low self esteem (although in most cases not as low as before) after DART. For those who scored within the normal range at the beginning the vast majority stayed the same or improved but a few mothers moved into the low self esteem category after DART. So although most mothers improved there were some who still had low self esteem after the intervention.
- Ok so I’m now going to look at the changes to the children’s clinical categories to the sdq after DART. - Hopefully a lot of you will be familiar with the strengths and difficulties questionnaire- it is a very well known one. Children are rated on a range of criteria by their parents in terms of their behaviours and it looks at areas such as their peer relationships, emotional difficulties, conduct difficulties and also prosocial behaviour. Based on their scores they are categorised as either having low needs- meaning low levels of difficulties in these areas, some needs or high needs. So looking children who were categorised as ‘high need’ in terms of their overall difficulties at T1 changed after DART you can see from the top column that 45.5% of those who were identified as having high needs moved into a lower ‘need’ category after DART- however although most children’s difficulties scores reduced 54.5% remained in the high need category. The ‘some need’ group appeared to be easier to change with over 71% moving into the low need group after DART. So this suggests that although overall children’s difficulties reduced, some of those with the highest needs before DART may need further intervention, or more time to recover. Interviews with DART practitioners and mothers from DART supported this finding as they felt that although things had improved for some families with more complex they had not fully recovered from the experience and might benefit from further intervention. Practitioners said that there are a number of other external factors which can affect some of the families’ well-being- e.g. there is a greater risk of homelessness, financial hardship, isolation (after moving to a new area to get away from perpetrator). So in some cases additional support is needed. In instances where the families are still identified to have high levels of need after DART, the service centers may provide more one to one work and will work with external agencies such as women’s aid and domestic abuse safety units so that the family still have support.
- Practitioners with mothers, children and practitioners were themed to identify aspects of the programme which worked well and led to positive outcomes (facilitators) and barriers which may hinder outcome achievement. A few of the barriers and facilitators are detailed here (haven’t got time to talk about all of them so focussing on the ones considered most key) The joint sessions were seen as really important as they enabled children to share their views and experiences of the abuse with their mothers in a supportive environment. Mothers were often shocked at the extent to which their children remembered and were affected by abusive incidents. Understanding more about how their child had been affected helped mothers to understand how this could relate to their child’s challenging behaviours and helped them to support their child, reassure them about anxieties. Because some of the children on the programme were as young as seven it was important that the activities were child-friendly and the creative activities really enabled them to share their experiences and introduce sensitive topics. One example is where children are asked to create a house where domestic abuse happens and with the support of a practitioner they describe their creation to their mother. This was considered a really powerful activity as some children created very accurate depictions of real life events- and then would go on to describe their thoughts and feelings. Mothers said that they could be shocked and upset by this activity but that it really made them realise what their child had experienced, and reinforce their desire not to resume an abusive relationship. The skills of practitioners were crucial in order that they could create a friendly and non-threatening environment where mothers and children felt that they could safely express their feelings and feel supported. Separate sessions were also considered important in order that mothers and children could hear from peers with similar experiences and realise that they were not alone in their experience, and also so that the mothers could discuss their experiences in more depth than would be appropriate in front of children.
- Early interviews with DART practitioners identified that they felt that the programme manual was too prescriptive and that not all activities were suitable for all individuals- some of the older children would find some of the activities too ‘babyish’- this led to a change in the manual, which enabled practitioners to use their professional judgement more when choosing activities. They were allowed to adapt activities to suit the needs of the group, as long as programme outcomes were adhered to. Contact with perpetrator- e.g. court ordered contact could have a negative impact. Ex partners would sometimes reinforce the child’s negative behaviours towards the mother. In instances when the mothers resumed relationships with the perpetrator this could have a detrimental affect on the child’s well being Some group members could dominate the session, others could say things in front of the children which mothers and practitioners considered inappropriate Some mothers were described as overwhelmed by the group situation and struggled to engage. Some were not ready to hear about their child’s experience as they were still struggling to process their own experience of the abuse.
- - Overall the evidence suggests that DART is an effective approach and that it helps to support the recovery of mothers and children who experienced domestic abuse. However, some families, particularly those with higher or more complex levels of need may need additional support to recover fully and multi-agency working is important in order that these families can access relevant support. Some mothers may need a bit of additional support before the group in order that they are in the right place to engage fully and consider the effect of the abuse on their children. The DART intervention has more recently been adapted on this basis in order that mothers who are considered to need more support to engage are able to attend some pre-group sessions. These pre-group sessions are designed to emotionally prepare mothers for the group and work through any issues that may prevent them from participating fully. The next stage is to evaluate this adapted intervention, to see what affects this additional element may have on attrition from the programme and outcomes.