MISC-IPV: A Community Based Intervention for Children Traumatized By Intimate Partner Violence

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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.