ABSTRACT
One in four children (26%) in the U.S. are exposed to intimate partner violence (IPV), with higher rates among
children of
African American
women. IPV exposure constitutes a traumatic stress environment with severe
consequences for psychosocial outcomes in children. While maternal caregiving has been identified as a
critical buffer against the effects of trauma on children, current IPV parenting interventions suffer from
cultural
insensitivity
, and design and methodological limitations impeding scalability. Our scientific premise is that the
adverse effects of IPV trauma on children can be interrupted through an intervention that enhances maternal
caregiving capacity, and which is delivered by community-based paraprofessional caseworkers who are
already delivering services to IPV-exposed
African American
women. The objective of this application is to
adapt an established caregiver intervention program, Mediational Intervention for Sensitizing Caregivers
(MISC), for the IPV and
African American
context (thereafter named MISC-IPV). MISC-IPV will be evaluated
for acceptability, feasibility, and preliminary mechanisms and outcomes, guided by an evidence-based
framework consisting of three aims (Adapt, Process Evaluation, Outcome/Mediator Evaluation). For Aim 1,
(Adapt), we will adapt MISC through an
iterative process
involving qualitative interviews and focus groups with
caseworkers and mothers in an IPV rehousing program
until fit with context is achieved
. Cultural adaptation
and adaptation for the IPV context will be guided by a Community Advisory Board. For Aim 2 (Implementation
and Process Evaluation), we will recruit
N = 132
mothers/child pairs (children age 7 to 11) through the Harris
County Domestic Violence Coordinating Council (HCDVCC) Collaborative of Houston, TX. Half will be
randomly assigned to TAU+MISC-IPV vs. TAU. After initial training of caseworkers, one year of bi-weekly
(every two weeks) intervention sessions of TAU+MISC-IPV vs. TAU will be delivered. Feasibility, adherence,
and fidelity will be evaluated through percentage of sustained engagement, individual interviews, video-based
observations, and questionnaire-based assessment. For Aim 3 (Outcomes and Mediators), we will evaluate
the effects of TAU+MISC-IPV vs. TAU to interrupt the traumatizing effects of IPV exposure on children through
assessing emotional, behavioral, and trauma symptoms at baseline, 6, 12, and 18 months in the children
recruited in Aim 2. The mediational effects of enhanced caregiving capacity will be assessed through video
observations and increase in knowledge. At the end of this formative study, we will have established the
foundational assessments and intervention to apply for a multi-site RCT to fully test the efficacy, mediators,
and moderators of MISC-IPV. This project will make possible a culturally sensitive, developmentally
transportable, scalable, and sustainable evidence- and community-based intervention with proven in-vivo
mechanisms of change that may serve as a model for future IPV programs also in different populations, that
address the needs of IPV-exposed mothers and children simultaneously.