The effectiveness of a psycho-educational program for child witnesses and victims of interparental violence.|
|- candidate number||10330|
|- NTR Number||NTR3064|
|- ISRCTN||ISRCTN wordt niet meer aangevraagd.|
|- Date ISRCTN created|
|- date ISRCTN requested|
|- Date Registered NTR||9-sep-2011|
|- Secondary IDs||15701.2001 / 80-82435-98-8010/3; ZonMw / METC VUmc|
|- Public Title||The effectiveness of a psycho-educational program for child witnesses and victims of interparental violence.|
|- Scientific Title||The effectiveness of a psycho-educational preventive program for child witnesses and victims of interparental violence, an RCT design.|
|- ACRONYM||The effectiveness of the psycho-educational program “En nu ik…!”|
|- hypothesis||The purpose of this study is to conduct a randomized controlled trial with the psycho-educational preventive intervention program ‘En nu ik…!’ (Now it’s time for me!) and the control program ‘Jij hoort erbij’ (You belong too). In the intervention program, the focus is on learning how to cope with having experienced interparental violence. In every session a different aspect of this topic is covered. In the control program, the focus is not on the interparental violence, but on creating a positive, structured atmosphere.
This design is used to study:|
1. Program effectiveness in terms of reduction of internalizing, externalizing behavioral problems and posttraumatic stress symptoms;
2. Hypothesized moderating variables, such as level of posttraumatic stress symptoms of the child and the parent, psychopathology of the parent, parenting stress, duration and severity of the interparental violence and demographic variables;
3. Hypothesized mediator variables, such as parent-child interaction, emotional security, emotion awareness, self-blame and coping skills of the child.
Because of the design of this study in which children in the intervention and control program are compared, this study will provide knowledge about the effectiveness of the psycho-educational preventive intervention program ‘En nu ik…!’ and will also teach us about the need for trauma-focused programs compared to programs focusing on positive interactions.
|- Healt Condition(s) or Problem(s) studied||Posttraumatic stress symptoms, Emotional problems, Behavioral problems, Domestic Violence|
|- Inclusion criteria||1. The child has witnessed interparental violence;|
2. In the child’s current living situation interparental violence does not occur;
3. The child is aged between 6 and 12 years;
4. The non-violent caregiving, custodial parent and the child are willing to participate in the program;
5. Parent(s) have given informed consent for participation in the study.
|- Exclusion criteria||1. The child has an intellectual disability;|
2. The behavioral problems of the child are so severe that (s)he can not function in a group;
3. One or both of the parents do(es) not agree that the child participates in this study.
|- mec approval received||yes|
|- multicenter trial||yes|
|- Type||2 or more arms, randomized|
|- planned startdate ||15-nov-2008|
|- planned closingdate||15-mei-2013|
|- Target number of participants||140|
|- Interventions||Intervention program “En nu ik…!” (“Now it’s time for me!”).|
The program “En nu ik…!” partly stems from the preventive psycho-educational intervention program “Kids’ Club” (Graham-Bermann, 1992) and has been adapted by the Women Shelter in Amsterdam (Blijf Groep), Centre of Youth Care in Amsterdam (BJAA/SO&T), social work and mental health care institutions in Amsterdam. The program is standardized and follows a protocol every week. “En nu ik...!” consists of nine sessions for children of 90 minutes each and parallel sessions for their non-violent custodial parent. The program is based on trauma theory (Perry, 1993), emotional security hypothesis (Cummings, Davies & Campbell, 2000) and attachment theory (Bowlby, 1973).
The program ‘En nu ik…!’ has three intervention goals for children:
1. To (make a start with) process(ing) the interparental violence experiences;
2. To learn how to express emotions and how to cope with feelings and problems in a different (non-violent) way and;
3. To learn protection skills (enlarging social network, how to call 911).
In every session the same structure is followed to create a safe predictable environment. Every activity is related to the topic covered that week and varies per session. A different topic is covered each of the nine sessions:
1. Getting to know each other and recognizing emotions;
3. Sadness or happiness and a safe place;
5. Disputes and loyalty;
6. Violence, disputes and contact with the violent parent;
7. Secrets and safety;
8. The future, and;
9. Saying goodbye and evaluation.
Parents may not be very responsive towards their children because of their preoccupation with their own traumatic experiences. For this reason the parallel parent sessions are developed. In these sessions parents learn how to support their children in coping with their experiences and emotions and they receive information about how the interparental violence may impact the child as well as their role as a parent. Furthermore, they can interact with parents with similar experiences and can make a start with processing their own experiences.
The program consists of nine sessions and topics covered are:
1. Getting to know each other, emotions and violence;
2. Parenting: the role as a parent and the role as a child;
3. A safe place, offering safety, making compliments;
4. Coping with feelings of anger and sadness;
5. Coping with feelings of guilt, shame and loyalty;
6. Safety, disputes and contact with the violent parent;
7. Social contacts and social network;
8. Unspecified theme, depending on the needs of the participants, and;
9. Saying goodbye and evaluation.
Control program “Jij hoort erbij” (“You belong too”)
The control program follows the same structure as the intervention program and also consists of nine sessions for children of 90 minutes each and parallel sessions for their non-violent custodial parent. “Jij hoort erbij” is a standardized program and follows a protocol every week. This program was carefully developed to only include non-specific intervention factors such as positive attention, structure, contact with people with similar experiences and support of a caring group leader. There is no focus on the trauma nor on coping skills.
In the children’s sessions of the control program a safe positive atmosphere is created in which children can be themselves. The control program follows a comparable structure as the intervention program (e.g. start in a circle and holding hands, a break halfway through the session, ending the sessions with parents and children together). Every session the children do a fun activity, comparable with activities offered in community centres:
1. Getting to know each other;
2. Playing games;
3. Healthy food and painting dinner plates;
4. Decorating a name plaque;
5. Relaxing: Watching a movie/playing video games;
6. Painting a club shirt;
7. Scouting expedition;
8. Making a goodbye movie, and;
9. Saying goodbye and evaluation.
In the parent sessions parents receive information about their role as a parent, their personal development and the importance of relaxation. Covered topics are:
1. Getting to know each other and relaxation;
2. Fun things to do with your child(ren);
3. Healthy food;
5. Books to read together with your child(ren);
6. How to keep a budget;
7. Creative activities;
8. Bingo, and;
9. Saying goodbye and evaluation.
The difference between the intervention and control program is that in the control program no specific attention is paid to the interparental violence and the focus is on positive attention in a safe, structured environment.
|- Primary outcome||The main question of this study is whether children who experienced interparental violence benefit from participating in ?En nu ik?!? in terms of a stronger decrease in posttraumatic stress symptoms (TSCYC, TSCC), in externalizing behavior problems and in internalizing behavior problems (CBCL, CDI) after participating in the intervention program compared to children participating in the control program.|
|- Secondary outcome||Hypothesized mediators are parent-child interaction (FIT, AEED, DAI), feelings of emotional security within the family (SIFS: secure), coping skills (HICUPS), feelings of guilt (CERQ-k: self-blame) and the ability to differentiate and express emotions (EAQ: differentiating emotions). Posttraumatic stress symptoms of the parent (IES-R) and the child (TSCYC, TSCC), psychopathology of the parent (HADS), duration and severity of the interparental violence (CTS2, CTS-PC), parenting stress (NOSI-k) and demographics are examined for their moderating role. Control variables are new potential stressful or traumatic experiences and treatment integrity.|
|- Timepoints||Measurement points:|
Baseline (T1): One week before the program starts;
Post-test (T2): One week after finishing the program = three months after baseline;
Follow-up (T3): Six months after finishing the program = nine months after baseline.
|- Trial web site||http://www.emgo.nl/research/mental-health/research-projects/1096/|
|- status||inclusion stopped: follow-up|
|- CONTACT FOR PUBLIC QUERIES||Dr. Mathilde M. Overbeek|
|- CONTACT for SCIENTIFIC QUERIES||Dr. Mathilde M. Overbeek|
|- Sponsor/Initiator ||VU University, Department of Clinical Child and Family Studies|
(Source(s) of Monetary or Material Support)
|ZON-MW, The Netherlands Organization for Health Research and Development|
|- Brief summary||Every year approximately 100.000 children in the Netherlands are exposed to interparental violence. These children are at a heightened risk for developing psychosocial-, behavioral and cognitive problems, as well as posttraumatic stress symptoms. For these children the psycho-educational preventive program ‘En nu ik…!’ (Now it’s time for me!) has been developed. The main aim of the present study is to evaluate the effectiveness of this program and the need for trauma-focused programs compared to programs focused on positive interactions. A secondary objective is to study hypothesized mediating and moderating variables to gain insight into how the program works and for whom it works the best.
This study is designed as a prospective multicenter randomized controlled trial in different cities across the Netherlands. Children, aged 6-12 years, and their caregiving custodial parents, who experienced interparental violence are randomly assigned to either the intervention program or the control program. Primary outcome measures are posttraumatic stress symptoms and emotional and behavioral problems of the child. Hypothesized mediators are parent-child interaction, feelings of security within the family, coping skills, feelings of guilt and the ability to differentiate and express emotions. Posttraumatic stress symptoms of the parent and the child, psychopathology of the parent, duration and severity of the interparental violence, parenting stress and demographics are examined for their moderating role. Data are collected one week before the program starts (T1) and one week (T2) and six months (T3) after finishing the program. |
|- Main changes (audit trail)|
|- RECORD||9-sep-2011 - 4-okt-2011|
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