Title: IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): An evidence synthesis
Funder: Department of Health (England)

Abstract: The aim of our project is to produce recommendations for future research evaluating interventions for childrenexposed to domestic violence and abuse (DVA). We will do this by synthesising the findings of previous studies bymodeling the cost effectiveness of known interventions and by consulting with survivors of DVA their children andservice providers. Exposure to DVA is an adverse childhood experience that increases the risk of behavioural andmental health problems throughout childhood and into adult life (Chan & Yeung 2009; Stanley 2011) as well asthe risk of adult DVA perpetration and victimisation (Whitfield 2003; Murrell 2007). The association with these pooroutcomes is cumulative in the presence of other adverse childhood experiences which often co-occur withexposure to domestic abuse (Radford et al. 2011; Finkelhor et al. 2009). Longitudinal research with childrenexposed to domestic violence and research with perpetrators indicate that change may be difficult to implement orsustain. However it is plausible that if interventions with children exposed to domestic abuse improve short-termbehavioural and mental health outcomes they will also reduce the risk of adult DVA perpetration and victimisation. DesignPhase I: evidence synthesis This will be based on a wide range of evidence sources (listed below). We will distinguish the effectiveness of interventions byage and gender of children exposed to DVA and highlight contextual factors such as agencies delivering theprogrammes and the communities in which they are based:1. Controlled studies (international)In a previous systematic review (Feder 2009) we identified 5 studies (4 RCTs) evaluating interventions with childrenexposed to DVA and the non-abusing parent. We will update this review and quality appraisal summarising themain findings and pooling the child-centred outcomes if possible.2. Cohort studies (international)Including longitudinal studies measuring outcomes for children exposed to domestic abuse engaged in interventionprogrammes or studies measuring protective factors that may be the basis of future intervention. We will summarisethe main findings.3. Qualitative evaluations of interventions (international)Including interview- based and observational studies of children with or without a parent engaged in interventionprogrammes. We will combine findings through a qualitative synthesis (Feder 2006) identifying promisinginterventions and research gaps.4. Project reports (UK)Including any published account that reports outcomes for children exposed to domestic abuse engaged in anintervention programme. We will combine findings identifying promising interventions and research gaps.We will identify studies potentially fulfilling our inclusion criteria through bibliographic database searches byscrutinising references and citations and by contacting topic experts and service providers.Phase II: cost-effectiveness and expected value of information modeling of intervention(s)We will review higher quality epidemiological studies (well powered cross-sectional population studies measuringpotential confounding factors or longitudinal studies) that measure the association between childhood exposure toDVA and adverse adult outcomes including DVA perpetration and victimisation. These will give us a range of effectestimates of childhood exposure. We will then use the effect size of the trials measuring short-term behaviouraloutcomes of interventions for children exposed to abuse (see phase I) to project the potential long term effect of theinterventions into adulthood using a range of assumptions about attenuation/amplification. Our estimates oflong-term outcomes will include perpetration and victimisation mental health educational achievementemployment and involvement with criminal justice systems If cost data for the interventions are available we propose a cost effectiveness analysis based on the pooled trials or the trial with the highest internal and external (in the UK policy context)validity. Even if cost data are not available we will be able to estimate these from current UK costs of interventionprogrammes allowing us to consider benefits and costs averted up to early middle age. This will allow us to projectthe potential cost-effectiveness of the intervention in the UK context and the potential benefit in terms of reducingdomestic abuse victimisation and perpetration and other adult outcomes. That model will be the basis for anexpected value of partial perfect information analysis which will identify which subsets of parameters areresponsible for uncertainty in the optimal policy decision and will directly inform a recommendation on whetherspecific interventions should be further tested. If appropriate an expected value of sample information analysis willbe performed to identify the optimal design of further research. (Griffin 2010) It is possible that some of theinterventions should be implemented without further research.Phase III: consultationWe will identify a group of stakeholders including Child and Adolescent Mental Health Services (CAMHS) professionals 3rd sector organisations and social care agencies delivering programmes for children exposed to domestic abuse as well as academics in the field of DVA. Meetings will be held with this group to identify which interventions are currently delivered in the UK and which would benefitfrom further evaluation. We will also discuss the findings of phases I and II with this group feeding their views intothe research recommendations. A pre-existing group of young people will also be consulted through Hyndburn andRibble Valley Domestic Violence Team (HARV ) in East Lancashire. Throughout the synthesis we will consult two patient and public involvement groups consisting of survivors ofdomestic violence in Bristol and Cardiff initially established to support PROVIDE (http://www.provide.ac.uk/) anNIHR applied research programme. The groups each numbering 6-10 women will inform the detailed design of thesynthesis input their views when the findings are interpreted and when the research recommendations aredeveloped and disseminated.Phase IV: Final formulation of research recommendations and dissemination of findings including research design types of interventions potential comparators duration of intervention(s) target population groups potential outcome measures. Outputs will include reports to funders and relevant agenices.Timetable (18/12) monthsPhase I: 1-14Phase II: 12-16Phase III: 4-16Phase IV: 14-18


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: MENTAL HEALTH