How far does screening women for domestic (partner) - NIHR Health ...

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Review Question IV
Sullivan and colleagues considered the effect
of a 16-week advocacy intervention for abused
women and their children. 124 For details of the
intervention, see Advocacy interventions with
abused women above. Children’s scores for selfworth,
physical appearance and athletic ability all
increased, and the effect of the intervention on
these variables was found to be significant over and
above the effects of time. Children’s witnessing of
abuse decreased in both groups, and again this
effect was found to be significant over and above
the effects of time. Assailant’s abuse of the child
decreased in both the intervention and control
group, but the within- and between-groups change
decreases were not significant.
A before-and-after study by Ducharme and
colleagues evaluated an intervention seeking to
improve parent–child cooperation in women who
were not living with the abuser. 166 The geographical
region was not reported. Two groups received
immediate intervention and two received delayed
treatment. The intervention used ‘errorless
compliance training’, a success-based, noncoercive
intervention involving the hierarchical
introduction of more demanding parental requests
at a gradual pace, and lasted between 14 and 29
weeks. Mother–child dyads were self-referred
or referred from child welfare agencies, school
boards, women’s refuges and other social service
agencies. Children were aged between 3 and 10
years and had severe behaviour problems. All
of the children came from families where the
mothers had experienced partner violence. Data
for all four groups were pooled and showed that
all children demonstrated increased compliance
following the intervention. There was significant
improvement in perception by mothers of their
children’s externalising, internalising and total
behaviour problems. Mothers rated their children
as being significantly more cooperative after the
intervention, and reductions in maternal stress and
improvements on the parenting stress index were
seen both on child and parent characteristics.
Four of the five studies examining the effectiveness
of interventions with children of abused women
were randomised controlled trials and well
executed. These studies suggest that this type of
intervention is promising and helps to reduce
children’s behaviour problems and mother’s stress
and PTSD symptoms. Such interventions may also
increase a mother’s child management skills. The
majority of these interventions were conducted with
women who had left the abusive relationship, so
these findings may not be generalisable to women
who remain with an abusive partner.
Sensitivity analysis
As we did not meta-analyse the studies, we could
not formally test the effect of study quality on
pooled effect sizes with a subgroup analysis
or metaregression. We examined variation for
comparable outcomes (see Appendix 7.5) and
made a qualitative judgment on whether study
quality was related to effect size. Before-and
after studies were not included in this sensitivity
analysis due to the inherent risk of bias in this
study design. Where studies did not report effect
sizes, values for Cohen’s d between group effect
sizes were calculated using means and standard
deviations when such data were present. There
were a sufficient number of studies measuring
PTSD, depression, self-esteem and physical
abuse to explore study quality on these outcomes.
Five studies (four RCTs) measured PTSD as an
outcome. 142–146,160,161 The better-quality studies
had smaller effect sizes. 162–166 Five studies (four
RCTs) measured the effects of the intervention
on depression, 126,142–146,150,157 with the betterquality
studies showing smaller effect sizes. Four
studies (two RCTs) 138,140,143–146,152,153,157 measured
the effects of the intervention on self-esteem.
There was no clear relationship between effect size
and study design and execution. Three studies
(all RCTs) 121,123,126,140 measured the effects of
interventions on physical abuse. There was little
variation in the effect sizes, which were all low.
This sensitivity analysis highlights the importance
of a high standard of design and execution of
intervention studies.
Strengths of this review
We did not exclude studies on the basis of
language, translating those that were not reported
in English. We appraised the quality of all primary
studies: the Jadad score was applied to randomised
controlled trials, and all studies were appraised
using the USPSTF quality criteria, which give a
measure of internal and external validity, and also
the strength of evidence of the studies as a whole,
which can be used to assess the level of evidence for
the particular type of intervention being assessed.
Effect sizes were calculated where means and
standard deviations were reported or obtainable
from the authors. Our review meets all the relevant