PROJECT SUPPORT

Evidence-Based Practice for Children Exposed to Domestic Violence

Renee McDonald Ernest N. Jouriles

FAMILY RESEARCH CENTER

SOUTHERN METHODIST UNIVERSITY

Overview and Objectives

 Who are the families?

 What are the components of the intervention?

  What is important to know, to do?

What does it look like “on the ground”?

Getting to Know You

     Who has provided services…  To families with children exposed to domestic violence?

 To women in violent relationships?

That are manualized?

That are skills-based?

That are offered in families’ homes?

That are empirically supported?

That blend casework and mental health services?

Beliefs and Values: Influence on Helping Relationship

     What causes DV? Where does it come from?

What should a woman do when it happens?

Why do women stay in abusive relationships?

What problems might DV cause for children?

How does a perpetrator become a perpetrator?

How might beliefs and values that you hold influence how you help your clients?

How might they get in the way of being helpful?



Examples

If we believe marriage is forever and divorce is wrong, it may be hard to see a marriage end, even when it’s due to DV.  If we believe the only way to end DV is to end the relationship, it may be hard to help a victim who chooses to stay in the relationship.

Context: Our Beliefs and Values

      Our relationships with families are the most powerful tools we have in our work. Engagement, Rapport, Caring We are humbled by the difficulties these families face and amazed by their resilience.

We are honored and grateful that they allow us to enter their lives – their homes – and get to know them. They usually have good reasons for the choices they make, even if they are different than the choices we would make.

A tightly focused, skills-based intervention can bring about positive changes in the children’s and families’ lives.

Adjustment of children exposed to DV

25% – 70% have adjustment problems

MOST PREVALENT: Conduct Problems

Many have other adverse circumstances and risk factors Ending their exposure to violence is an important goal, but it is seldom enough to resolve the children’s problems

Barriers to Services

Most parents with IPV don’t seek mental health services for their children 1.

Other important priorities  Logistics barriers  o o o Scheduling Child care Time off from work Safety 2.

o o o Don’t understand significance and potential outcomes of conduct problems “ It’s just a stage” “She’ll grow out of it” “Boys will be boys ” 3.

o o o Some obtain services, but Short duration Inconsistent attendance Timing: crisis and priorities

What we’ve done to help Project Support

■ Empirically-based treatment designed to reduce conduct problems among children aged 4-9 exposed to frequent and severe domestic violence.

■ Adapted to be sensitive to the varying circumstances (adversity package) of violent families

Key Points for Project Support

 Priority: Engagement and Retention  Assistance with co-occurring problems and stressors  Social support & instrumental support  Focus on child mental health outcomes  Skills-based  Improve quality of parent-child relationship  Improve parental effectiveness

For whom is it appropriate?

 Age of children (4-9)  Help them early  Help them before it’s too late  Other issues  Significant parental substance abuse or dependence  Severe mental illness in mother or child  Neurological impairment of mother or child   Significant head injury Autism  Significant mental retardation in mother or child Otherwise, any child who appears to need the services .

Project Support: What Comes First

 Engage the families     Have a conversation about their view of the problems (esp. the children) Describe the services Invite and answer questions

Provide emotional support

 If they are interested in services ■ Assess to identify the children with problems (interview, standardized measures) ■ Conduct family needs assessment

The family is interested, now what?

■ Continued focus on engagement  Stay in touch, take time and listen  Offer assistance (assess needs) & follow up  Coordinate with other professionals  Don’t lose them!

 No shows?

 If you lose them, find them!

 Continued engagement and relationship building

Let’s Get Started: Social and Instrumental Support

Structure

   Offer to come by, begin services Assess safety concerns Schedule first assessment and treatment appointment  Begin services   Weekly home visits Flexible schedule

A Note on Safety

1.

Family safety A.

Always trust the woman’s sense of danger B.

Some partners remain in the home C.

Mothers may include partners if they wish (and if therapist deems it safe) D.

Intervention is suitable for mothers and fathers  It is NOT couples therapy 2.

Staff safety A.

Teams and times B.

Neighborhoods C.

Signals

Relationship Style (Process)

■ Suspend judgment and preconceptions • Be open and curious • • Invite and ask rather than instruct Banish

should, must, ought, need

■ Resistance?

• Failure to engage • Failure to understand client perspective ■ Parenting skills are tailored to the child & family – not “cook-book” application ■ Model, model, model • • • Thinking aloud Problem-solving (formal and informal) Advocacy • • • Assess and re-assess The skills Affirm the positives

Social and Instrumental Support Content

 Assessing the client’s problems  What areas?

 How bad?

 What she has tried, what she thinks she can do  What kind of help would she need  Help with Resources  Access to community resources  Advocate   Transportation Fax, phone, internet  Problem-solving & decision-making skills  Balance: Helping & professional role  Social Support (continued engagement)  Stay in touch, follow up on problems, successes, requests 

Demonstrate that we care

Needs Assessment

Families will readily join with you if they believe: • That you understand their perspective on what’s important • That you have the potential to help

Shifting to the Children: Identifying Problems and Strengths

 Find out from the client what the problems are and what solutions she has tried.  You want:  Information about what she thinks are problems that her children have.

 Some idea of her own sense of confidence and her approach to raising her children  To get enough information to have a pretty good idea of some of her strengths and how you might begin helping her with her problems.

Assessing Child Problems: Sample Questions

Sometimes when kids have seen a lot of violence, it’s hard for them...

1.

How do you think it may have affected your children?

2.

3.

4.

5.

6.

• What things do they do that make you concerned, or angry, or worried?

Be very specific o o When your child does this, what does it look like?

What does he/she say and do?

o o How often does this happen?

Are there certain things that seem to always make it happen?

• • What things have you tried?

What do you say to him/her when this happens?

How does she/he respond?

• • What has worked well? Poorly?

Is there anything you’ve done that stopped it, even if just for a little while?

Is there anything that has made it worse?

What are the things you feel best about in your children?

In your parenting?

Case 1: Engagement, social/instrumental support, child problems

      28, single, with 4 children     6 months 3 years (aggressive) 6 years 10 years (mentally ill)  Did not finish high school; does not have a GED Has worked as a cook Income is $600/month Lives in a 1 bedroom apt. Has no family, no car Completely financially dependent on partner  The most important thing is to keep the family together and to “be a family.”    Children “don’t do what I say” “I can’t control my oldest” “We cannot go out in public”

Role Play

With the person next to you (one be the client, one the therapist), you have the following goals:

1.

2.

3.

• • • Get to know the client/circumstances Identify her concerns about her children’s adjustment When you’re done, she should Feel that you truly understand her situation Have a sense of hope that you can offer her real, tangible help Feel that her children and her relationship with them are a meaningful part of the discussion Priorities:  Engagement   Many questions; few statements • • Assistance with co-occurring problems and stressors What has she tried and how has it worked?

Provide social support & instrumental Support   Assess child mental health Understanding from her perspective

Questions to Ask: Cheat Sheet

Sometimes when kids have seen a lot of violence, it’s hard for them...

1.

2.

3.

How do you think it may have affected your children?

What things do they do that make you concerned, or angry, or worried?

• Be very specific o o When your child does this, what does it look like?

What does he/she say and do?

o o How often does this happen?

Are there certain things that seem to always make it happen?

What things have you tried?

• • What do you say to him/her when this happens?

How does she/he respond?

4.

5.

6.

• • What has worked well? Poorly?

Is there anything you’ve done that stopped it, even if just for a little while?

Is there anything that has made it worse?

What are the things you feel best about in your children?

In your parenting?

What worked well?

Client:   Feeling understood A sense of hope and efficacy  Your children, and your relationship with them, are a meaningful part of the process   Therapist:  What values or beliefs were you aware of?

 What was difficult?

What felt “right”?

What felt “wrong”  Did you feel you would be able to help this family? How?

 Either: Any feelings of judging or being judged?

Services that target children’s problems

II. Parenting and the Parent-Child Relationship

Enhancing the Parent Child Relationship

Relationship Enhanced

• Increase positives • Decrease negatives

Children & Families Happier Behavior Problems Eliminated

How hard can it be to improve a mother’s relationship with her children?

Very hard

■ Conduct problems are challenging to the best of parents ■ Parenting components easy to understand, hard to learn to use ■ Few families come for agency mental health services consistently ■ 2-3 sessions typical ■ Parenting classes: “

Been there, done that

.”

Skills: Rationale & Sequencing

Increasing Positives Attending Decreasing Negatives Reprimand & Redirect Praise & Positives Listening & Comforting Ignoring Time Out •Potency •Frequency •Duration Directions Rewards & Privileges Warmer Parent-Child Relationship Improved Child Adjustment

Key Points

 Sequencing of skills  Positives/relationship enhancement first Sometimes sufficient  Negatives/discipline strategies last Always do them  Skills are cumulative  Focus on skill mastery at each step 1.

2.

3.

4.

5.

Assessment Role plays Homework and corrective action Review Repeat  “Dose” of treatment  Amount and allocation of session time (this can be challenging)  Average number of sessions: 20

Questionable Assumptions

If you’re teaching mothers to parent differently, aren’t you implying that… 1.

Mothers caused the problems?

  Other factors than parenting also contribute Adjustment is multiply determined

2.

Mothers are not parenting properly?

 May be adequate for most children, but not those with significant conduct problems  Parenting gone awry: Coercive cycle Mothers as change agents:

Mothers can help correct the problems regardless of their cause.

Skills-Based Approach



Evidence of effectiveness: Data



Overcoming barriers: Skills training can’t work if…

1.

The therapist doesn’t deliver it  Crises and life stressors sometimes make it challenging 2.

3.

If it’s not tailored to the specific child, parent, and circumstances The mother doesn’t use it  Not all clients respond the way we would like them to

Skills-Based Approach: Pros & Cons?

 Choose where to spend your time 1.

May seem to contradict the methods some are trained to use 2.

However, therapists always make choices about what to intervene on and when; you can’t do everything, and you can’t do many things at the same time…pacing  May feel like “ignoring” underlying issues, not getting at the “root causes” 1.

Learning the skills opens up opportunities to address these underlying issues.

2.

Some think the root causes are changes in the parent-child relationship that have unfolded over time, ways the child has learned and internalized about how to think and respond in certain situations. If you address those you would be getting at the root causes

Staying on Task

■ Committed focus on skills and competence ■ Careful balance between mom/family and child issues ■ Tailoring the skills and approach to the specific family and child ■ Deliberate effort on getting through the skills ■ The skills don’t work identically for every child. Paying attention to when they don’t seem to be working is as important as paying attention to when they do.

How we do the skills part…

1.

Introduce the skill a) What is it?

b) Why use it?

c) Dos and don’ts Assess and address mom’s understanding & comfort 2.

Begin role play with mom (first time is hard) a) Therapist as mom, Mom as child   Assess mom’s understanding & comfort Affirm positives of mom’s role playing the child b) Reverse roles and repeat c) Assess mom’s understanding & comfort  Affirm positives of mom’s role play  Talk about weaknesses in positive terms o

Great at paying attention to the details of what she was doing. You commented on how big the flower was and what a pretty red color she chose. Now we just need to work on getting a few more of those statements in to replace some of the questions .

d) When assured of success, role play between mom and child

A brief example: Case 2

    Mid 30s, married, 5 children (4-22) Husband visits regularly, she’s not sure what she wants from their relationship.

Works as a hotel housekeeper Life is hard. She wants to protect her children from being hurt by life.

    Criticizes them to teach them Doesn’t play with them They don’t show affection toward her Doesn’t give them things they haven’t earned

First Skill: Attending

DEFINITION: NARRATING BEHAVIOR 1.

    What is it?

Paying attention in a diferent way Learning to purposefully deploy attention Using attention to help teach the child what you expect May not make immediate sense, but it will later as we build on it 2.

 Why use it?

To help your child do more of the things you want to see, and less of what you don’t want to see.

3.

    What to do Allow the child to pick a fun task (coloring) Observe and describe what the child is doing Use intonation to convey enthusiasm (“sportscaster”) Be specific enough that someone listening from another room would know what the child was doing 4.

   What not to do Don’t ask questions Don’t make suggestions Don’t teach

An “Attending” Role Play

Pair off again, but this time reverse roles, and this is what you do:

 Introduce the skill (a limited example) 1.

What it is & rationale a) Paying attention, but in a different way b) c) Forms the basis of all the other skills Idea is to narrate ( “sportscaster”, listener) d) Child chooses activity e) Mom can play only if invited and then only follows the child f) Comment espe cially on things you want to see more of 2.

Dos and don’ts a) Follow the child’s lead b) c) Use inflection and emotion in your voice Don’t teach, instruct or ask – just comment Now, you try it…

What worked?

Moms    How was that?

What felt “right”?

Any discomfort?

 What about the practice?

Therapists      Similarities and differences?

Difficulties?

What felt “right”?

Any discomfort?

What about the role play?

 If you did it again, how would you do it differently?

Nuts and Bolts

1.

Master’s Level Therapists trained in   Skills-based parenting intervention Cognitive-behavioral (social learning) principles  Safety protocol o For families o o For staff Co-therapy training model 2. Small caseloads (2-3 cases)      Intensive supervision (group) Home visits take time Work outside of sessions takes time Crises take time Burnout prevention and support 3.

    Child care – we bring our own!

Child mentors (1-2)  Undergraduates, for course credit Trained in child management skills NOT babysitters Take games, toys, crafts

Anything else?

 Persistence, perseverance, working hard to keep them! (may be different from traditional approaches) ■ Lots of effort to keep in touch and keep going  If we don’t work hard to identify o and help these children, who o ■ Keeping focused, working on the parenting and child problems even when mothers lose interest  Continued engagement, continuity of service staff (same therapist and mentor)  Mechanisms for tracking/locating families  Well-functioning relationships with collaborative partners – at all levels

Contact Information

Renee McDonald, Ph.D.

Associate Professor of Psychology Co-Director, Family Research Center Southern Methodist University P.O. Box 750442 Dallas, TX 75275-0442

Phone:

214-768-1128

Email:

[email protected]

Ernest N. Jouriles, Ph.D.

Professor of Psychology Co-Director, Family Research Center Southern Methodist University P.O. Box 750442 Dallas, TX 75275-0442

Phone:

214-768-2360

Email: [email protected]