Project Support : En genomförbarhetsstudie av ett individuellt föräldrastöd i socialtjänsten för våldsutsatta föräldrar

Genomförbarheten av Project Support (PS), ett individuellt föräldrastöd för våldsutsatta mammor utvecklat i USA, utvärderas inom ramen för svensk socialtjänst i denna studie. Sammanlagt trettio behandlare har utbildats i metoden, som anpassats till svenska förhållanden i samarbete med upphovsmännen. Tjugonio familjer hade inkluderats i behandling vid sttudiens avslut. Såväl behandlare som mammor uppskattade metoden och bedömde att den var en lämplig insats som förbättrade föräldrarnas samspel med sina barn. Mammornas självskattade föräldraförmåga förbättrades signifikant, och barnens symtomnivåer sänktes. Vissa svårigheter för implementering identifierades, dels metodspecifika, dels relaterade till omständigheter i socialtjänsten.Insatser för våldsutsatta bar

Outcomes of psychotherapeutic and psychoeducative group interventions for children exposed to intimate partner violence

Witnessing violence toward a caregiver during childhood is associated with negative impact on children's health and development, and there is a need for effective interventions for children exposed to intimate partner violence in clinical as well as in community settings. The current effectiveness study investigated symptom reduction after participation in two established group interventions (one community-based psychoeducative intervention; one psychotherapeutic treatment intervention) for children exposed to intimate partner violence and for their non-offending parent. The study included 50 children—24 girls and 26 boys—aged 4–13 years and their mothers. Child and maternal mental health problems and trauma symptoms were assessed pre- and post-treatment. The results indicate that although children showed benefits from both interventions, symptom reduction was larger in the psychotherapeutic intervention, and children with initially high levels of trauma symptoms benefited the most. Despite these improvements, a majority of the children's mothers still reported child trauma symptoms at clinical levels post-treatment. Both interventions substantially reduced maternal post-traumatic stress. The results indicate a need for routine follow-up of children's symptoms after interventions

Reduced psychiatric symptoms at 6 and 12 months’ follow-up of psychotherapeutic and psychoeducative group interventions for children exposed to intimate partner violence

Background: Long-term follow-up studies of interventions for children exposed to intimate partner violence are few, and the sustainability of their outcomes often remains unexplored and uncertain. Current research including follow-up assessment suggests that treatment gains may be maintained or continue post termination. In addition some children may show increased levels of symptoms. Objective: The present effectiveness study investigated the long-term outcomes of two established group interventions for children exposed to intimate partner violence and their non-offending parent. Participants and Setting: The study included 50 children, 24 girls and 26 boys, aged 4 to 13 years attending a psychotherapeutic child and adolescent mental health service intervention and a psychoeducative community-based intervention. Methods: Background information, child and parental mental health problems, trauma symptoms, and exposure to violence were assessed pre- and post treatment and at 6 and 12 months’ follow-up. Results: Sustained treatment gains and late improvements in children's internalizing and externalizing symptoms and in symptoms of traumatic stress were recorded from post treatment to the follow-up assessments (p =.004–.044; d = 0.29–0.67). No significant increase in symptoms was reported. Additionally, very little continued or renewed child exposure to violence was reported. Conclusions: The results of the study indicate that the children did benefit from the two interventions studied and that the outcomes of reduced child symptoms and protection from exposure to violence were sustainable. Children with severe trauma symptoms benefited the most, though maternal psychological problems may for some have hindered recovery. Clinical implications are discussed

Replicability of effect when transferring a supportive programme for parents exposed to intimate partner violence and their children from the US to Sweden

Transferring an evidence-based parenting programme for parents exposed to intimate partner violence (IPV) and their children with emotional and behavioural problems reveals the extent to which cultural and social aspects can interfere with the programme’s effectiveness. Feasibility studies are of value in such circumstances, and the aim of the present feasibility study was to explore, on a small scale and in its natural context, whether the effects of the parenting programme, Project Support, were replicable when transferred to another country. In this study, the programme, which was originally designed for parents exposed to IPV and their children who had developed psychological symptoms in the United States, was evaluated in an equivalent population receiving Swedish social services. Parents (n = 35) self-assessed their parenting capacity and their children’s (n = 35) psychological symptoms. The results indicate that the parents improved their parenting capacity, and feelings of helplessness and fear regarding parenting their children decreased. Those feelings were also associated with the children’s psychological symptoms. The promising results are similar to the findings of previous research from the US, and further implementation and evaluation of Project Support in Sweden are indicated

The professional relationship forms the base : Swedish child health care nurses' experiences of encountering mothers exposed to intimate partner violence

Purpose This study aimed to explore child health care nurses' clinical experiences from encounters with mothers exposed to intimate partner violence (IPV), as little research has explored this topic. Method Nine child health care nurses from two Swedish regions were interviewed. The interviews were analysed using thematic analysis. Results The narratives depicted the nurses' strong commitment to, and professional relationship with, the exposed mothers. The experience of working as a nurse and having encountered IPV in clinical practice made the nurses more confident, which impacted their performance and attitude towards this topic. The ability to uphold the professional relationship was threatened by lack of support and interprofessional collaborations. Conclusions The professional relationship was central to the encounters, yet could impose an emotional burden on the nurses. While the nurses wanted to improve their knowledge of the process around the mother and child, they were happy to pass the primary responsibility over to other professionals. The findings highlight the challenge in establishing sustainable support for nurses, and building a transparent collaboration process between the health care sector and the social services, serving the well-being and safety of the mother and child

Patient participation in forensic psychiatric care : Mental health professionals' perspective

Patient participation is a central concept in modern health care and an important factor in theories/models such as person-centred care, shared decision-making, human rights approaches, and recovery-oriented practice. Forensic psychiatric care involves the treatment of patients with serious mental illnesses who also have committed a crime, and there are known challenges for mental health staff to create a health-promoting climate. The aim of the present study was to describe mental health professionals' perceptions of the concept of patient participation in forensic psychiatric care. Interviews were conducted with 19 professionals and were analysed with a phenomenographic approach. The findings are presented as three descriptive categories comprising five conceptions in an hierarchic order: 1. create prerequisites – to have good communication and to involve the patient, 2. adapt to forensic psychiatric care conditions – to take professional responsibility and to assess the patient’s current ability, and 3. progress – to encourage the patient to become more independent. The findings highlight the need for professionals to create prerequisites for patient participation through good communication and involving the patient, whilst adapting to forensic psychiatric care conditions by taking professional responsibility, assessing the patient’s ability, and encouraging the patient to become more independent without adding any risks to the care process. By creating such prerequisites adapted to the forensic psychiatric care, it is more likely that the patients will participate in their care and take more own responsibility for it, which also may be helpful in the patient recovery process

The Effectiveness of Child-Parent Psychotherapy on Traumatized Preschoolers and Their Caregivers : A Swedish Multi-Site Study

Introduction: Trauma affects a child’s mental health and appears to be associated with challenges in caregiver-child dynamics. Nearly half of child trauma victims are under the age of six, yet few interventions are designed for this age group. Child-Parent Psychotherapy (CPP) is an attachment-based trauma treatment for preschool-aged victims of adversities and their caregivers. This study examines the effectiveness of CPP when implemented in a Swedish naturalistic multi-site clinical setting. Method: 57 children (age 2–6 years) with potentially traumatic experiences and their caregivers participated. They were recruited from 12 mental health services providing child treatment. The study has a one-group, pretest-posttest design. Outcome measures covered posttraumatic stress and general psychological symptoms in children and caregivers and caregivers’ perceptions of their relationship with their child. Paired t-tests were used to calculate within-group differences. Effect sizes were computed as Cohen’s d and associations between child and caregiver outcomes as Pearson’s correlation coefficient (r). A hierarchical regression analysis was tested to explore the correlation analysis. Results: Reductions in posttraumatic stress and general psychological symptoms with small-to-medium effect sizes were found in children and caregivers. Caregivers reported perceived improvements in their relationship with their child, with associations to findings in child posttraumatic stress reduction. Discussion: Findings support earlier results that CPP may be a suitable choice of treatment for preschoolers exposed to potentially traumatic events, such as violence. The dyadic treatment model seems to address the association between child traumatic stress and caregivers’ perceptions of the caregiving relationship. Further dissemination testing is suggested