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The effects of parental components in a trauma-focused cognitive behavioral based therapy for children exposed to interparental violence: study protocol for a randomized controlled trial.

Visser MM, Telman MD, de Schipper JC, Lamers-Winkelman F, Schuengel C, Finkenauer C - BMC Psychiatry (2015)

Bottom Line: Indirect effects refer to deteriorated parental availability and parent-child interaction.Primary outcome measures are posttraumatic stress symptoms, and internalizing and externalizing problems in children.It will illuminate mechanisms underlying change by considering multiple dimensions of child responses, parenting variables and identify selection criteria for participation in treatment.

View Article: PubMed Central - PubMed

Affiliation: KJTC (Children's Trauma Center Haarlem), Zuiderhoutlaan 12, Haarlem, 2012 PJ, The Netherlands. m.m.visser@vu.nl.

ABSTRACT

Background: Interparental violence is both common and harmful and impacts children's lives directly and indirectly. Direct effects refer to affective, behavioral, and cognitive responses to interparental violence and psychosocial adjustment. Indirect effects refer to deteriorated parental availability and parent-child interaction. Standard Trauma Focused Cognitive Behavioral Therapy may be insufficient for children traumatized by exposure to interparental violence, given the pervasive impact of interparental violence on the family system. HORIZON is a trauma focused cognitive behavioral therapy based group program with the added component of a preparatory parenting program aimed at improving parental availability; and the added component of parent-child sessions to improve parent-child interaction.

Methods/design: This is a multicenter, multi-informant and multi-method randomized clinical trial study with a 2 by 2 factorial experimental design. Participants (N = 100) are children (4-12 years), and their parents, who have been exposed to interparental violence. The main aim of the study is to test the effects of two parental components as an addition to a trauma focused cognitive behavioral based group therapy for reducing children's symptoms. Primary outcome measures are posttraumatic stress symptoms, and internalizing and externalizing problems in children. The secondary aim of the study is to test the effect of the two added components on adjustment problems in children and to test whether enhanced effects can be explained by changes in children's responses towards experienced violence, in parental availability, and in quality of parent-child interaction. To address this secondary aim, the main parameters are observational and questionnaire measures of parental availability, parent-child relationship variables, children's adjustment problems and children's responses to interparental violence. Data are collected three times: before and after the program and six months later. Both intention-to-treat and completer analyses will be done.

Discussion: The current study will enhance our understanding of the efficacy interparental violence-related parental components added to trauma focused cognitive behavioral group program for children who have been exposed to IPV. It will illuminate mechanisms underlying change by considering multiple dimensions of child responses, parenting variables and identify selection criteria for participation in treatment.

Trial registration: Netherlands Trial Register NTR4015 . Registered 4th of June, 2013.

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Related in: MedlinePlus

Research procedure. After informed consent is obtained for all parent-child dyads to form a group, they will all participate in the T1 assessments. Parents and children are asked to fill out questionnaires and to participate in two observational tasks. Additionally, the parent is interviewed with respect to the observational tasks. After T1, the group will be randomly assigned to one of the four treatment conditions by an independent researcher using a randomization procedure with lottery drawings. Condition 1 & 2 will start one week after T1, and condition 3 & 4 will start seven weeks after T1. One week (T2) and six months (T3) after the end of the program, parents and children are again invited to fill out questionnaires. At all assessments, the teacher is also sent a questionnaire
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Fig2: Research procedure. After informed consent is obtained for all parent-child dyads to form a group, they will all participate in the T1 assessments. Parents and children are asked to fill out questionnaires and to participate in two observational tasks. Additionally, the parent is interviewed with respect to the observational tasks. After T1, the group will be randomly assigned to one of the four treatment conditions by an independent researcher using a randomization procedure with lottery drawings. Condition 1 & 2 will start one week after T1, and condition 3 & 4 will start seven weeks after T1. One week (T2) and six months (T3) after the end of the program, parents and children are again invited to fill out questionnaires. At all assessments, the teacher is also sent a questionnaire

Mentions: This multi-center study examines the addition of two parental components to a TF-CBT-based treatment for children exposed to IPV, which results in a 2 (preparatory program present versus absent) x 2 (parent-child interaction present versus absent) factorial randomized experimental component trial. The study includes pre-treatment (T1), treatment, post-treatment (T2), and a 6-month follow-up (T3) assessment, and will include 100 children and their custodial parents (Fig. 1 depicts the study design). The baseline assessment (T1, see Fig. 2) will take place one week prior to the start of the 6-week preparatory program. To ensure comparability across treatment conditions, in the “No preparatory program” condition, parents and children will be assessed 7 weeks before the beginning of the TF-CBT-based treatment. Additionally, parents and children will be assessed three times during treatment, namely at the beginning of the intervention (session 1), after sharing the trauma narrative of the child with the parent (session 9), and at the end of the intervention (session 15). These measurements allow us to test mediating pathways [47], and allow us to monitor, and if necessary control for, new IPV or other stressful incidents. The second assessment (T2) will take place one week after the last session of the TF-CBT-based treatment for all four conditions. The third assessment (T3) will be at a follow-up, six months after the last session of the treatment. Regardless of condition, all participants receive the standard TF-CBT-based treatment. The difference lies in the addition of the two parental components. Families who are assigned to “No preparatory program“ or “No parent-child interaction” conditions will not receive an alternative component additionally to standard TF-CBT based treatment.Fig. 1


The effects of parental components in a trauma-focused cognitive behavioral based therapy for children exposed to interparental violence: study protocol for a randomized controlled trial.

Visser MM, Telman MD, de Schipper JC, Lamers-Winkelman F, Schuengel C, Finkenauer C - BMC Psychiatry (2015)

Research procedure. After informed consent is obtained for all parent-child dyads to form a group, they will all participate in the T1 assessments. Parents and children are asked to fill out questionnaires and to participate in two observational tasks. Additionally, the parent is interviewed with respect to the observational tasks. After T1, the group will be randomly assigned to one of the four treatment conditions by an independent researcher using a randomization procedure with lottery drawings. Condition 1 & 2 will start one week after T1, and condition 3 & 4 will start seven weeks after T1. One week (T2) and six months (T3) after the end of the program, parents and children are again invited to fill out questionnaires. At all assessments, the teacher is also sent a questionnaire
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4477299&req=5

Fig2: Research procedure. After informed consent is obtained for all parent-child dyads to form a group, they will all participate in the T1 assessments. Parents and children are asked to fill out questionnaires and to participate in two observational tasks. Additionally, the parent is interviewed with respect to the observational tasks. After T1, the group will be randomly assigned to one of the four treatment conditions by an independent researcher using a randomization procedure with lottery drawings. Condition 1 & 2 will start one week after T1, and condition 3 & 4 will start seven weeks after T1. One week (T2) and six months (T3) after the end of the program, parents and children are again invited to fill out questionnaires. At all assessments, the teacher is also sent a questionnaire
Mentions: This multi-center study examines the addition of two parental components to a TF-CBT-based treatment for children exposed to IPV, which results in a 2 (preparatory program present versus absent) x 2 (parent-child interaction present versus absent) factorial randomized experimental component trial. The study includes pre-treatment (T1), treatment, post-treatment (T2), and a 6-month follow-up (T3) assessment, and will include 100 children and their custodial parents (Fig. 1 depicts the study design). The baseline assessment (T1, see Fig. 2) will take place one week prior to the start of the 6-week preparatory program. To ensure comparability across treatment conditions, in the “No preparatory program” condition, parents and children will be assessed 7 weeks before the beginning of the TF-CBT-based treatment. Additionally, parents and children will be assessed three times during treatment, namely at the beginning of the intervention (session 1), after sharing the trauma narrative of the child with the parent (session 9), and at the end of the intervention (session 15). These measurements allow us to test mediating pathways [47], and allow us to monitor, and if necessary control for, new IPV or other stressful incidents. The second assessment (T2) will take place one week after the last session of the TF-CBT-based treatment for all four conditions. The third assessment (T3) will be at a follow-up, six months after the last session of the treatment. Regardless of condition, all participants receive the standard TF-CBT-based treatment. The difference lies in the addition of the two parental components. Families who are assigned to “No preparatory program“ or “No parent-child interaction” conditions will not receive an alternative component additionally to standard TF-CBT based treatment.Fig. 1

Bottom Line: Indirect effects refer to deteriorated parental availability and parent-child interaction.Primary outcome measures are posttraumatic stress symptoms, and internalizing and externalizing problems in children.It will illuminate mechanisms underlying change by considering multiple dimensions of child responses, parenting variables and identify selection criteria for participation in treatment.

View Article: PubMed Central - PubMed

Affiliation: KJTC (Children's Trauma Center Haarlem), Zuiderhoutlaan 12, Haarlem, 2012 PJ, The Netherlands. m.m.visser@vu.nl.

ABSTRACT

Background: Interparental violence is both common and harmful and impacts children's lives directly and indirectly. Direct effects refer to affective, behavioral, and cognitive responses to interparental violence and psychosocial adjustment. Indirect effects refer to deteriorated parental availability and parent-child interaction. Standard Trauma Focused Cognitive Behavioral Therapy may be insufficient for children traumatized by exposure to interparental violence, given the pervasive impact of interparental violence on the family system. HORIZON is a trauma focused cognitive behavioral therapy based group program with the added component of a preparatory parenting program aimed at improving parental availability; and the added component of parent-child sessions to improve parent-child interaction.

Methods/design: This is a multicenter, multi-informant and multi-method randomized clinical trial study with a 2 by 2 factorial experimental design. Participants (N = 100) are children (4-12 years), and their parents, who have been exposed to interparental violence. The main aim of the study is to test the effects of two parental components as an addition to a trauma focused cognitive behavioral based group therapy for reducing children's symptoms. Primary outcome measures are posttraumatic stress symptoms, and internalizing and externalizing problems in children. The secondary aim of the study is to test the effect of the two added components on adjustment problems in children and to test whether enhanced effects can be explained by changes in children's responses towards experienced violence, in parental availability, and in quality of parent-child interaction. To address this secondary aim, the main parameters are observational and questionnaire measures of parental availability, parent-child relationship variables, children's adjustment problems and children's responses to interparental violence. Data are collected three times: before and after the program and six months later. Both intention-to-treat and completer analyses will be done.

Discussion: The current study will enhance our understanding of the efficacy interparental violence-related parental components added to trauma focused cognitive behavioral group program for children who have been exposed to IPV. It will illuminate mechanisms underlying change by considering multiple dimensions of child responses, parenting variables and identify selection criteria for participation in treatment.

Trial registration: Netherlands Trial Register NTR4015 . Registered 4th of June, 2013.

Show MeSH
Related in: MedlinePlus