Kjerstin Almqvist, Ph. D. professor in medical psychology,

1. Support to children who have experienced violence against their mother – Preliminary results from a national evaluation study in Sweden Kjerstin Almqvist, Ph. D. professor in medical psychology, Department of Psychology, Karlstad University & County Council of Värmland.

2. Gothenburg University Research group Professor project adm. Ass. professor Doctoral stud Anders Broberg Linnéa Almqvist Ulf Axberg Karin Grip Karlstad University Uppsala University Örebro University Professor psychologist Kjerstin Almqvist Ulrika Sharifi Ass. Professor doctoral stud. Maria Eriksson Clara Iversen Ass. Professordoctoral stud.Åsa Källström Cater Anna Forssell

3. Intimite Partner Violence (IPV) and violence against women in Sweden. • 11 % of Swedish women have been exposed to IPV (Lundgren et al, 2001). • Xx % of Swedish children describes violence between their parents (Jansson, 20xx). • Women with preschool children are at highest risk (Bair-Meritt et al., 2008). • Most children are present when the abuse of their mother take place (Almqvist & Broberg, 2004). • About 60 % of children are abused when their mother is exposed to IPV (Almqvist & Broberg, 2004).

4. Background • A number of agencies offering interventions to women and children exposed to intimate partner violence (IPV) have been established in Sweden in recent years as the social services has been given responsibility to offer support through changes to the Social Services Act. • The effects of such interventions are so far unknown. • The Swedish guvernement decided 2007 to implement a national plan against violence against women and their children. One of the aims was to evaluate different treatment models. • In this study preliminary results from a national evaluation are presented.

5. The National evaluation study of interventions for children who have experienced violence against their mother. 17 units throughout Sweden have participated in the evaluation study, 8 offering interventions especially aimed for children exposed to IPV and 9 offering treatment as usual (such as child and adolescent psychiatry) Inclusion to the study: August 2008 - April 2010. Mothers and children were evaluated pre-, post (6 months) and one year post intervention. Final interview april this year. 222 mothers with 302 children are included., varav 184 från specialverksamheterna, inkluderats i studien. 1 januari 2011 skedde en avrapportering till regeringen baserad på ett urval av 200 barn i åldern 3-13 år, som inkluderades i studien före 2009-06-30.

6. Agencies and treatment units in the evaluation Agencies focusing on children exposed to violenceTrappan ”Steps”- individual councelling for children exposed to IPV. (Södertälje, Uppsala, Huddinge) • ”Children- are- people –too”, group programme for children exposed to IPV. (Göteborg, Gävle) • ”Way out”, group programme for children exposed to IPV (Göteborg, Skaraborg) • Trauma focused group psychotherapy for children exposed to IPV (Stockholm) Treatment as usual offering support for children • Child- and adolescent psychiatry (Stockholm, Karlstad, Göteborg) • Social service (Karlstad) Social service unit without support for children ”Custody unit”(Göteborg)

7. Some facts about the mothers About 75 % of Swedish origin (25 % immigrants) Median age 36 y, in average 2 children Utbildningsnivå i genomsnitt avslutat gymnasium samt 1-2 års högskolestudier Relativt låg social status (på gränsvärdet) Relativt hög andel långtidssjukskrivna (11 – 22 % ) 2/3 living alone 8 % living together with the perpetrator

8. Some facts about the mothers • About 80 % exposed to violence the year before the intervention • 9 % exposed to fysical violence and 39 % for psychological violence the last 6 months they took part of the evaluation study. • 2/3 only exposed to violence by their current partner • Självskattad psykisk hälsa (BSI) och känsla av sammanhang (KASAM) klart lägre är normdata.

9. Some facts about the children 105 pojkar och 95 flickor 3 – 13 år, 62 % < 8 y For 87 % of the children, their biological father was the perpetrator of the violence against their mother. More than 60 % of the children had, according their mother, been abused by their father. In spite of that joint custody was predominant (51 – 75 %) Most children lived with their mother (64 – 83 %) Most children (52 – 66 %) whos father had exposed their mother (and themselves) to violence visited their father every fortnight according legal decision.

10. Mothers to children who had participated in interventions specially aimed for children exposed to IPV • Were generally very contented with the intervention • Rated the importance for the children of the intervention higher than mothers who’s children received treatment as usual • Were more …benägna to recommend the treatment unit to others, than mothers who’s children received treatment as usual • More frequently thaught their children had been enthusiastic about joining • And that the intervention had been valuable for their children • And that their communication with their children had improved • Rated that their children were improved more than mothers who’s children received treatment as usual (effekterna små eller måttliga).

11. Effect of treatment interventions - mothers Received decreased levels of psychiatric symptoms (BSI), especially mothers who participated in interventions aimed for women exposed to IPV. Received decreased levels of posttraumatic symptoms (EIS-R), especially mothers who participated in interventions aimed for women exposed to IPV.

12. Children’s psychological well-being according their mothers (SDQ) + p ≤ 1,00; * p ≤ 0,05; ** p ≤ 0,01¸*** p ≤ 0,001

13. Children’s psychological functioning according their mothers (SDQ Imp) + p ≤ 1,00; * p ≤ 0,05; ** p ≤ 0,01¸*** p ≤ 0,001

14. Children who had participated in the programmes showed Improved emotional regulation Decreased emotional reactivity Improved social and emotional ability

15. Mother’s rating of the different interventions for childrens + p ≤ 1,00; * p ≤ 0,05; ** p ≤ 0,01¸*** p ≤ 0,001

16. Slutsatser och rekommendationer • Särskilda verksamheter för barn som upplevt våld mot mamma utgör ett viktigt komplement till övriga insatser och fortsatt utveckling av dem bör stödjas. • Riskbedömningar och ett säkerhetsperspektiv måste få större betydelse i hanteringen av barn och mammor som utsatts för våld i nära relationer. • Barns rätt till behandling och stöd när de påverkats negativt i sin utveckling och psykiska hälsa av våld i föräldrarelationen behöver stärkas. Det ska räcka med att en vårdnadshavare begär stöd för barnet för att detta ska erbjudas.

17. Slutsatser och rekommendationer • Barn- och ungdomspsykiatrin behöver implementera specifika metoder för att behandla barn som traumatiserats och utvecklat en egen psykiatrisk problematik som följd av att mamma utsatts för våld. • Verksamheter med särskild inriktning på barn som upplevt våld mot mamma, socialtjänst och barn- och ungdomspsykiatri behöver utveckla samverkan kring dessa barn och deras mammor som innebär att barnens rätt till rätt insatser kan mötas. • Mammor som utsatts för våld i sin nära relation behöver tillgång till adekvata behandlingsinsatser för sina posttraumatiska symtom.