Verwey Jonker Institute

• Within-family changes in violence, stress, and child PTS were unrelated over time. • Change patterns within families are similar for mandatory and voluntary CPS. • Intra-familial processes are complex and require customized support. The current study aimed to examine the within-family longitudinal associations between family violence, parental stress, and child post-traumatic stress (PTS) symptoms in families involved in the Dutch child protection system. Specifically, differences in within-family longitudinal associations between families receiving mandatory and voluntary child protection services (CPS) were investigated using multi-group Random Intercept Cross Lagged Panel Models. A total of N = 1015 parents ( N = 331 mandatory CPS; N = 684 voluntary CPS) reported on the frequency of family violence, the level of parental stress, and child PTS symptoms at three timepoints over the course of 1.5 years using validated questionnaires. The results showed that within-family changes in family violence, parental stress, and child PTS symptoms were not related over time, except parental stress at the second wave predicted child PTS symptoms half a year later. However, this cross-paths disappeared when adding covariates to the model. On the between-family level, the associations between the random intercepts of family violence and parental stress, and parental stress and child PTS symptoms were significant, indicating that changes primarily occur on the between-family level and are mainly cross-sectional. No differences were found between families receiving mandatory and voluntary CPS. Intra-familial change might be more complex and might occur at a different pace than hypothesized in this study.

ABSTRACT Child safety is an important outcome of child protection services (CPSs); however, this is often assessed in terms of official registries (e.g., rereports). Little empirical evidence is available about how the frequency of child maltreatment changes during CPS intervention by using self‐report measures. The present study evaluates the frequency of child maltreatment experienced by children receiving mandatory child protection support compared to carefully matched children receiving voluntary child protection support. The current study is part of an ongoing Dutch longitudinal study on family violence consisting of several cohorts with similar designs. Both parents and children reported on the frequency of child maltreatment using validated questionnaires at two timepoints, 12 months apart. To facilitate careful comparison, both groups were matched using propensity scores based on background variables, resulting in two groups of N = 178 children. GLMM analyses showed a significant decrease in the mean number of child maltreatment incidents over time in the total group. However, this decrease did not differ for children receiving mandatory and voluntary child protection support. The findings indicate that, despite possible motivational challenges in the mandatory group, mandatory child protection support elicits comparable results as voluntary support. Implications for further research and practice are discussed.

This paper describes the practice of an integrated family approach to treatment in mental health care in which the focus is on the whole family and treatment is carried out by professionals of adult and child mental health services together. It is presented as an example of a best practice in finding a way to overcome barriers in implementing an integrated family approach in treatment for the benefit of families with a variety of interrelated problems. Even though there is a lot of knowledge about the importance of a family approach in mental health care with specific attention to the patients' parental role, the children, family relationships, and the social economic context, this is worldwide rarely implemented in the practice of mental health care. Barriers to keep the whole family in mind are identified on different levels: organizational policy, interagency collaboration, professionals, and patients themselves. As a solution, a model of an integrated family approach in mental health care is presented: how it is defined; which domains in the family are targeted; which key elements it contains; what the treatment consists of; and which procedures are followed in practice. A case illustrates how this approach might work in practice.

ObjectiveThe purpose of this study was to evaluate a collaborative community-based program that aims to a) increase the health, safety and talent development of youth, and b) contribute to the reduction of socioeconomic inequalities. MethodsA difference-in difference design with two separate cross-sectional samples in 2018 (n = 984) and 2021 (n = 413) among 0- to 12-year-olds with an intervention and comparator condition was used. The program, called Promising Neighbourhoods, consists of collaboration with community stakeholders, data-based priority setting, knowledge-and theory-based policies, and evidence-based interventions. The program was implemented in three neighbourhoods which were compared with three similar comparator neighbourhoods in which the program was not implemented. Logistic difference-in-difference regression was used to test effectiveness of the intervention on informal parenting support, outdoor-play, sport club membership, general health and risk of emotional and behavioural difficulties and to examine differences in intervention effects between children with a lower or higher socioeconomic status. ResultsA significant intervention effect of the Promising Neighbourhoods program after two-years was found for outdoor-play (OR 0.61; 95%CI 0.37, 0.99). No other significant intervention effects were found for other outcomes. No different interventions effects were found for children with a lower or higher socioeconomic status on outcomes. ConclusionThe findings of this study indicate a positive intervention effect for one of the outcomes in 0- to 12-year-olds. Further mixed-methods evaluation research and using longer follow-up periods are needed to examine the value of these type of programs. Further development of Promising Neighbourhoods seems warranted. Trial registrationThis study was prospectively registered in the Netherlands National Trial Register (Number: NL7279) on 26 September 2018.

Children exposed to family violence are at risk for developing long-lasting problems. Family violence is a pervasive problem, however, studies comparing continuation with cessation of family violence are limited. Understanding the cessation or continuation of family violence on child development is a prerequisite to prevent enduring problems and develop interventions. This study compares posttraumatic stress and delinquent behavior of children aged between eight and eighteen years for whom severe violence continues to children for whom violence diminishes or ceases. Children (N = 162, 43% boys, mean age 12 years) and their parents reported to child protection services (CPS) with severe violence were included. Levels of family violence, posttraumatic stress and delinquent behavior were re-assessed after 18 months. Most families (74%) still experienced severe family violence at the second assessment despite involvement of CPS. Structural equation modelling was applied. In the group where violence diminished or stopped, delinquent behavior decreased. A decrease of posttraumatic stress only occurred when violence diminished but surprisingly no decrease was observed when violence stopped completely. The findings demonstrate that overall family violence is persistent. Differing paths can be discerned for delinquent behavior and posttraumatic stress, indicating different developmental and recovery pathways after cessation of family violence. Nonetheless, it is fair to state that specialized and long-term care is crucial.

BackgroundFamily violence is a common problem with direct adverse effects on children as well as indirect effects through disruption of parenting and parent-child relationships. The complex interrelationships between family violence, parenting, and relationships make recovery from psychological responses difficult. In more than half of the families referred to mental health care after family violence, the violence continues. Also, the effect sizes of “golden standard” treatments are generally lower for complex trauma compared to other forms of trauma. In the treatment of complex trauma, trauma-focused therapies including cognitive restructuring and imaginal exposure are most effective, and intensifying therapy results in faster symptom reduction. Furthermore, there is promising evidence that adding a parental component to individual trauma treatment increases treatment success. In family-based intensive trauma treatment (FITT), these factors are addressed on an individual and family level in a short period of time to establish long-term effects on the reduction of trauma symptoms and recovery of security in the family. This randomized controlled multicentre study tests if FITT is an effective treatment for concurrent reduction of trauma symptoms of children, improvement of parenting functioning, and increasing emotional and physical security in children, through the improvement of parent-child relationships.MethodsThe effectiveness of FITT will be tested by a RCT design. A total of 120 adolescents with a history of family violence and PTS symptoms will be randomized to (a) an intensive trauma treatment with a parent and systemic component (FITT), (b) an intensive trauma treatment without these components (ITT), and (c) treatment as usual (TAU, low-frequency trauma treatment with parent therapy and family sessions). Changes in children’s trauma symptoms, child and parent functioning, and emotional and physical security in the family will be monitored before, during, after, and at 3 months follow-up.DiscussionComparing these interventions with and without a high intensive frequency and parenting and family components can help to understand if and how these interventions work and can contribute to the ambition to recover from the impact of family violence and restore emotional and physical security for children and young people.Trial registrationNetherlands Trial Register Trial NL8592. Registered on 4 May 2020