Program

Sep 12, 2008

OVERVIEW

This intervention
was designed to help women who were leaving a shelter for battered women and
were in the process of setting up a home away from their batterer. The program
was specifically focused towards women who had a child between the ages of 4
and 9 who had exhibited behaviors that fit the DSM-IV criteria for oppositional
defiant disorder (ODD) or conduct disorder (CD). Thirty-six families were
randomly assigned into either a control group or a treatment group. The
treatment group took part in an intervention which attempted to provide
emotional and instrumental support for the mothers, as well as teach them child
management skills that would help decrease their child’s
conduct problems. Relative to the control group, mothers in the treatment group
had greater improvements in child management skills, and their children’s behavior improved at a faster
rate and were within the normative range of conduct problems by the end
of the study.

DESCRIPTION OF PROGRAM

Target population: Families with children
who have displayed clinical levels of conduct problems, are making the
transition out of shelters for battered women, and are in the process of
setting up homes independent of their batterers.

The intervention consists of two main components: providing
mothers with emotional and instrumental support as they make a transition out
of a shelter for battered women and attempt to start up again away from their
batterer and teaching them how to use effective child management skills, in an
effort to reduce their child’s conduct problems.

EVALUATION(S) OF PROGRAM

Jouriles, E. N., McDonald,
R., Spiller, L., Norwood,
W.D., Swank, P.R., Stephens, N., et al. (2001).Reducing Conduct Problems Among Children of Battered Women. Journal
of Consulting and Clinical Psychology, 69
(5), 774-785.

Evaluated population: Of the 36 participating
children, 26 were boys and 10 were girls. Twenty-six met the criteria for
oppositional defiant disorder (ODD), and 10 met criteria for conduct disorder
(CD). The mean age of the children was 5.7 years, while the mean age of the
mothers was 28 years. The mothers also had a mean of 11 years of education.
There were 11 African American mothers, 10 Caucasian, 12 Latino, 1 Asian
American, and 2 who classified themselves as Other.
The mean number of acts of violence experienced by the woman (from their
partner) during the last year was 68.4. Seventy-five percent of the
mothers reported that they had been beaten up by their partner, while 36%
reported that their partner had used or threatened to use a knife or gun
against them in the year before their shelter residence. All families were
low-income.

Approach: Families expressing interest
were given a screening appointment as long as they met the preliminary
requirements: Have a child between 4 and 9 years of age, and be able to
communicate in English. At the screening appointment set up to determine the
family’ eligibility for the study, the following requirements had to be met:
Report at least one physically violent act by a male partner in the last 12
months, and have at least one child between the ages of 4 and 9 who met the
DSM-IV criteria for oppositional defiant disorder (ODD) or conduct disorder
(CD). If more than one child met the criteria, the youngest child in the family
to meet the requirements was selected as the target child. Families with serious
mental illness were not allowed to participate in the study, but were offered
clinical referrals as appropriate. Families eligible during this in-shelter
screening appointment were followed after leaving the shelter to determine
eligibility at that point. In order to continue eligibility upon leaving the
shelter, families had to meet the following requirements: The mother and the
target child must be living together in the same household, the former partner
must not be residing in the household, the household had to be within 50 miles
of the shelter, and the residence had to be safe enough for the project staff
to visit regularly.

Of the 153 families who were initially screened, 73 met the
preliminary requirements during the in-shelter screening, and 40 continued to
be eligible to participate in the study after departure from the shelter. Of
these 40 families, 4 served as participants during the pilot stage of the
study, and the remaining 36 composed the final sample.

Families had an initial in-home assessment conducted shortly
after the family settled into their new residence. After this, they were
randomly assigned to either the control or intervention condition; each group
was made up of 13 families with a child who exhibited behavior consistent with
an ODD diagnosis, and 5 families with a child who exhibited behavior consisted
with a CD diagnosis. Assessments typically lasted 2-3 hours and were repeated
every 4 months, for a total of 5 assessments over a 16-month period. They
consisted of questionnaires for mothers and a 45-minute videotaped family
interaction. Thirty-one of the families were able to complete all five
assessments.

The intervention group participated in weekly in-home
sessions for up to 8 months after shelter departure. The sessions were 1-1.5
hours in length and were led by a team of trained therapists and advanced
students. There was flexibility in terms of the frequency of the sessions, with
some families not being able to make it to a session every single week, and
other families receiving more than one session a week – especially during times
of crisis. On average, families participated in 23 sessions over this period of
time. The intervention was made up of two primary components. The first was
providing families with social and instrumental support and mothers with
problem solving skills. Mothers received emotional support during their
transition out of the shelter and received help with physical resources and
social supports that promoted their effort to become self-supporting. They also
addressed safety concerns and received training on decision making and
problem-solving skills. The second component focused on teaching mothers skills
that would increase desirable child behavior, decrease undesirable child
behavior, help them communicate more effectively and develop a more warm and
positive relationship with their children. The control group participants were
contacted monthly but received no services from the team. They were instead
encouraged to make use of the services already provided in their community when
necessary. They also received referrals to services, when appropriate.

Measures used to assess treatment effects included the Child
Behavior Checklist (CBCL), which is a widely used measure of both externalizing
and internalizing problems. Mothers were also observed during 45-minute
sessions with their children, and later coded on their child management skills.
This looked at the extent to which mothers correctly used specific skills and
if they interacted with their children in an involved, affectionate and
responsive manner. The Symptom Checklist-90 Revised (SCL-90-R) was also used,
as an index of mother’s psychological distress.

Results: Researchers found that externalizing
problems improved over time for both groups, but they improved at a faster rate
among children who were part of the intervention, than among the children in
the control group. Children’s internalizing problems
also decreased over time; however, group differences were not statistically
significant. Mothers in the treatment group had significantly higher
levels of child management skills than mothers in the control group, and these
management skills also improved more rapidly in the treatment group. Mothers’
level of psychological distress diminished over time; however, no significant
differences were found across groups. Finally, researchers found that the level
of externalizing problems for the treatment group was within the normative
range by the end of the study, while the level of externalizing problems for
the children in the control group remained above the normative range.

SOURCES FOR MORE INFORMATION

References

Jouriles, E. N., McDonald, R.,
Spiller, L., Norwood,
W.D., Swank, P.R., Stephens, N., et al. (2001).Reducing Conduct Problems Among Children of Battered Women. Journal
of Consulting and Clinical Psychology, 69
(5), 774-785.

KEYWORDS: Early Childhood (0-5), Children (3-11), Middle
Childhood (6-11), Counseling/therapy, Home Visitation, Home-based,
Social/Emotional Health, Behavioral Problems, Oppositional Defiant Order,
Conduct Disorder, Externalizing Problems, Parent Management Skills, High-Risk,
Skills Training, Family Therapy, African American or Black, White or Caucasian,
Latino or Hispanic, Asian, Family Conflict, Problem-Solving Skills, Mental
Health

Program information last updated 9/12/08.

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