VU University, Department of Clinical Child and Family Studies, Amsterdam, The Netherlands.
Trials. 2012 Feb 6;13:12. doi: 10.1186/1745-6215-13-12.
Children who witness interparental violence are at a heightened risk for developing psychosocial, behavioral and cognitive problems, as well as posttraumatic stress symptoms. For these children the psycho-educational secondary prevention program 'En nu ik...!' ('It's my turn now!') has been developed. This program includes specific therapeutic factors focused on emotion awareness and expression, increasing feelings of emotional security, teaching specific coping strategies, developing a trauma narrative, improving parent-child interaction and psycho-education. The main study aim is to evaluate the effectiveness of the specific therapeutic factors in the program. A secondary objective is to study mediating and moderating factors.
METHODS/DESIGN: This study is a prospective multicenter randomized controlled trial across cities in the Netherlands. Participants (N = 140) are referred to the secondary preventive intervention program by police, social work, women shelters and youth (mental health) care. Children, aged 6-12 years, and their parents, who experienced interparental violence are randomly assigned to either the intervention program or the control program. The control program is comparable on nonspecific factors by offering positive attention, positive expectations, recreation, distraction, warmth and empathy of the therapist, and social support among group participants, in ways that are similar to the intervention program. Primary outcome measures are posttraumatic stress symptoms and emotional and behavioral problems of the child. Mediators tested are the ability to differentiate and express emotions, emotional security, coping strategies, feelings of guilt and parent-child interaction. Mental health of the parent, parenting stress, disturbances in parent-child attachment, duration and severity of the domestic violence and demographics are examined for their moderating effect. Data are collected one week before the program starts (T1), and one week (T2) and six months (T3) after finishing the program. Both intention-to-treat and completer analyses will be done.
Adverse outcomes after witnessing interparental violence are highly diverse and may be explained by multiple risk factors. An important question for prevention programs is therefore to what extent a specific focus on potential psychotrauma is useful. This trial may point to several directions for optimizing public health response to children's exposure to interparental violence.
目睹父母间暴力的儿童面临更高的发展心理社会、行为和认知问题以及创伤后应激症状的风险。针对这些儿童，开发了心理教育二级预防计划“En nu ik...！（轮到我了！）”。该计划包括针对情绪意识和表达、增强情感安全感、教授特定应对策略、发展创伤叙事、改善亲子互动和心理教育的特定治疗因素。主要研究目的是评估计划中特定治疗因素的有效性。次要目标是研究中介和调节因素。
方法/设计：本研究是一项跨越荷兰城市的前瞻性多中心随机对照试验。参与者（N=140）由警察、社会工作者、妇女庇护所和青年（心理健康）护理机构转介到二级预防干预计划。经历过父母间暴力的 6-12 岁儿童及其父母被随机分配到干预组或对照组。对照组通过提供积极关注、积极期望、娱乐、分散注意力、治疗师的温暖和同理心以及团体参与者之间的社会支持，在非特定因素方面具有可比性，这些方式类似于干预计划。主要结局指标是儿童的创伤后应激症状和情绪与行为问题。测试的中介因素是区分和表达情绪的能力、情感安全感、应对策略、内疚感和亲子互动。还检查了父母的心理健康、育儿压力、亲子依恋障碍、家庭暴力的持续时间和严重程度以及人口统计学因素对其调节作用的影响。在开始计划前一周（T1）、完成计划后一周（T2）和六个月（T3）收集数据。将进行意向治疗和完成者分析。
目睹父母间暴力后的不良后果是多种多样的，可能由多个风险因素解释。因此，预防计划的一个重要问题是特定关注潜在心理创伤的程度是否有用。这项试验可能为优化公共卫生对儿童遭受父母间暴力的反应指明了几个方向。
