At a glane

Intervention Therapeutic programs exclusively for children exposed to intimate partner violence differ in modalities, consisting of play therapy, group therapy with psychoeducation or counselling

Key populations Children exposed to intimate partner violence, all genders

Outcomes studied Child health, behaviour and development

Impact of the intervention Coming soon

Australian Evidence None of the studies presented findings from Australia or reported on the experiences of Aboriginal and Torres Strait Islander peoples

Risk of bias Coming soon

Intervention description

What are the key characteristics of the intervention?

Therapeutic programs for children exposed to intimate partner violence may be delivered exclusively to children or conjointly to children and their caregivers. The focus of this review are therapeutic programs for children only. These programs generally seek to improve children’s coping mechanisms, sense of self-control, self-esteem, skills such as communication and problem solving, and overall functioning. The interventions vary in format, and may be focused on group therapies, play therapy for individual children or their siblings.

Groups therapies assist children to process strong emotions in a supportive environment. They can also include psycho-educational components that cover topics related to: recognising and learning about family violence in a developmentally appropriate way, safety skills promotion, anger and conflict resolution, family cohesion, and discussion of children's sense of responsibility for their parents and for the violence. Specific activities may include: drama, art, music, crafts, games and exercise or movement body-based practices.

Play therapies create a safe space for children to process their exposure to intimate partner violence via play, and involve reflective activities, building self-confidence and encouraging expression. Sessions involve the use of various toys, crafts, and worksheet materials. Programs may be tailored with culturally sensitive approaches and content.

What does the intervention involve?

Where is the intervention set? Delivered in a variety of settings, most commonly women’s shelters and specialist family violence or community-based services

How is the intervention delivered? Primarily delivered face-to-face by graduate-level trained therapists

How frequently is the intervention delivered? Delivered with varying frequency and duration of delivery, based on a range of 12 days up to 10 weeks

What resources and costs are involved? No studies commented on the costs associated with the intervention

Theory of change

How is the intervention designed or theorised to work ?

The interventions are generally informed by ecologically based perspectives and offer developmentally appropriate therapeutic support. Specifically, play therapies are based on child-centred and non-directive approaches. Through the medium of play, children are empowered to express themselves and their inner world, make sense of their experiences and learn coping strategies.

Impact

This section speaks to the effectiveness of the studies.

The outcomes measured by the included studies focused on children’s general wellbeing and behaviours, conduct problems, externalising and internalising behaviours, aggression, anger, safety and support skills, cognitive function, anxiety, school learning success, peer social skills, and other physical and mental health.

The impact of this intervention cannot be determined at this stage, given most studies received a high risk of bias rating.

Effectiveness rating	Outcome	Description

Key populations

Has the impact of this intervention been tested with certain key populations?

Interventions were not designed for any specific cultural or ethnic groups, people with physical or mental disabilities, or health conditions. Some studies included African American participants only.The table below gives an overview of whether or not the intervention was examined with some key populations. The inclusion of these populations was guided by the National Plan to End Violence against Women and Children 2022-2032 and the Australian National Research Agenda to End Violence against Women and Children: 2023-2028.

= no studies
= at least 1 study mentions that population, but effectiveness wasn't tested with that population
= at least 1 study tests effectiveness with the population

Population	What do we know about this group?	Degree of knowledge
Aboriginal and Torres Strait Islander communities	0 studies examine the effectiveness of the intervention with this Aboriginal and Torres Strait Islander communities. Therefore, we cannot confirm the applicability of this intervention to this population.
Sexuality and gender diverse/LGBTIQA+	0 studies examine the effectiveness of the intervention with this population. Therefore, we cannot confirm the applicability of this intervention to this population.
Specific age groups (including older people, children and young people)	All studies examined the effectiveness of the intervention with children
Culturally and linguistically diverse (CALD) groups	1 study examined the effectiveness of the intervention with African American participants only.
Migrants and refugees	0 studies examine the effectiveness of the intervention with this population. Therefore, we cannot confirm the applicability of this intervention to this population.
People with disability	0 studies examine the effectiveness of the intervention with people with disabilities. Therefore, we cannot confirm the applicability of this intervention to this population.

Key considerations

This section summarises factors that may contribute to study results, factors that may be considered to facilitate better outcomes, and the transferability of the intervention to an Australian context.

What do we know about the intervention in Australia?

• No studies presented findings from Australia, and most studies were based in the United States.
• Further research is required to determine effectiveness and acceptability in an Australian context.

What should Australian stakeholders consider?

• Most studies required the intervention to be implemented by therapist with a Master’s or Doctorate level, often with specific training such as in play therapy.
• Further research is required to determine effectiveness and acceptability in an Australian context.

Included studies

Characteristics of primary studies included in the Intervention Review

Study and location	Design	Intervention	Sample	Risk of bias rating
Kot et al. (1998) United States	QED Comparison: Treatment as usual (care in the shelters) Qualitative data: No	Child-centered play therapy Duration and format: Individual face-to-face 12 sessions for 45minutes across 12 days - 3 weeks plus regular shelter programs delivered by counsellors Setting: Playroom in domestic violence shelters Costs: Not provided	NExp =11, NComp = 11 Children exposed to intimate partner violence, residents of shelters, all genders (female 54.54%), aged 4-10 years	Child health, behaviour and development
McWhirter (2008) United States	Single group pre-post study Comparison: N/A Qualitative data: No	Community-based group therapy Duration and format: Group face-to-face for 5 weeks, delivered by counsellors Setting: Not provided Costs: Not provided	N=46 children exposed to intimate partner violence, all genders, aged 6-12 years	Child health, behaviour and development
Patterson et al. (2018) United States	Single group pre-post study Comparison: N/A Qualitative data: No	Child-centered play therapy, culturally adapted for African American children Duration and format: Individual and group face-to-face, individual 6 weeks for 50 minutes, delivered by professional registered play therapists Setting: Early education afterschool program Costs: Not provided	N=12 children exposed to intimate partner violence, all genders (female 33.3%), aged 5-9 years, all African American	Child health, behaviour and development
Sudermann et al. (2000) Canada	Single group pre-post study Comparison: N/A Qualitative data: No	London (Ontario) Community Group Treatment Programme for Child Witnesses of Woman Abuse Duration and format: 10–12 group face-to-face sessions delivered by professional co-facilitators, plus inter-agency collaboration Setting: various settings including child protection service, children’s mental health centre, family and housing services, women’s shelter Costs: Not provided	N=31 children exposed to intimate partner violence, all genders (female 54.84%), aged 7-15 years	Child health, behaviour and development
Tyndall-Lind et al. (2001) United States	Quasi-experimental study with a control group Comparison: Waitlist Qualitative data: No	Sibling group therapy and individual child play therapy, plus regular shelter programs Duration and format: 12 face-to-face, 45-minute sessions of individual across a period of 12 days -3 weeks, 3-4 educational and recreational group sessions per week, delivered by counsellors plus regular shelter programs Setting: Women’s shelters Costs: Not provided	Sibling group therapy: NExp = 10, NComp = 11 Children exposed to intimate partner violence, all genders (female 60%), residing in shelters, aged 4-9 years Individual play therapy: NExp = 11, NComp = 11 Children exposed to intimate partner violence, all genders (female 54.54%), residing in shelters, aged 4-10 years	Child health, behaviour and development
Wagar & Rodway (1995) Canada	Randomised controlled trial Comparison: Waitlist Qualitative data: No	Group psychoeducational therapy Duration and format: 10 weekly sessions delivered by professional facilitator Setting: Not provided Costs: Not provided	NExp= 16, NComp = 22 Children exposed to intimate partner violence, all genders, aged 8-13 years	Child health, behaviour and development

References and further reading

Included Studies

• Kot, S., Landreth, G. L., & Giordano, M. (1998). Intensive child-centered play therapy with child witnesses of domestic violence. International Journal of Play Therapy, 7(2), 17−36. http://10.0.4.13/h0089421


• McWhirter, P. T. (2008). An empirical evaluation of a collaborative child and family violence prevention and intervention program. In G. R. Walz, J. C. Bleuer, R. K. Yep, G. R. Walz, J. C. Bleuer, & R. K. Yep (Eds.),Compelling Counseling interventions: Celebrating VISTAS' fifth anniversary (2)(pp. 221−227). Ann Arbor: American Counseling Association.


• Patterson, L., Stutey, D. M., & Dorsey, B. (2018). Play therapy with African American children exposed to adverse childhood experiences. International Journal of Play Therapy, 27(4), 215-226. http://10.0.4.13/pla0000080


• Sudermann, M., Marshall, L., & Loosely, S. (2000). Evaluation of the London (Ontario) community group treatment programme for children who have witnessed woman abuse. Journal of Aggression, Maltreatment & Trauma, 3(1), 127−146. http://10.0.5.20/J146v03n01_09


• Tyndall-Lind, A., Landreth, G. L., & Giordano, M. A. (2001). Intensive group play therapy with child witnesses of domestic violenceInternational Journal of Play Therapy, 10(1), 53−83. http://10.0.4.13/h0089443


• Wagar, J. M., & Rodway, M. R. (1995). An evaluation of a group treatment approach for children who have witnessed wife abuse. Journal of Family Violence, 10(3), 295−306. http://10.0.3.239/BF02110994

Additional evidence on the intervention

This list contains other evidence that was not eligible for the Intervention Review based on our selection criteria but may provide further information regarding the intervention.

• Rizzo, C. F., Macy, R. J., Ermentrout, D. M., & Johns, N. B. (2011). A review of family interventions for intimate partner violence with a child focus or child component. Aggression and Violent Behaviour,16, 144-166. http://10.0.3.248/j.avb.2011.02.004