The Impact of an Adapted Version of the Strengthening Families Program on IPV Among Caregivers and ACEs Among Children

Domestic Violence Clinical Trial

Official title: The Impact of an Adapted Version of the Strengthening Families Program on Reducing IPV Among Caregivers and ACEs Among Their Children (RCS Update)

Status Completed

Clinical Trial Summary

Adverse childhood experiences (ACEs) are unfortunately common and the known outcomes are concerning. However, very little is currently know about programs that may prevent ACEs among children such as witnessing IPV experienced by their caregivers. The purpose of this project is to adapt an existing evidence-based program (i.e., Strengthening Families) to prevent ACEs. A randomized control will be used to determine the initial efficacy of the program. The Strengthening Families program has demonstrated effectiveness in reducing substance use and initiation among youth and some preliminary evidence suggests that it may be effective at reducing child maltreatment as well. Further, the Strengthening Families program promotes family bonding and cohesion, which are protective factors against ACEs. The Strengthening Families program has been adapted by researchers at UNL (Devan Crawford and Les Whitbeck) for Native American Families (i.e., BII-ZIN-DA-DE-DAH [Listening to One Another]) to prevent substance abuse. Using the Strengthening Families and BII-ZIN-DA-DE-DAH programs, the investigators seek to adapt these programs to prevent ACEs among youth ages 10-14 and their caregivers. The program adaptations are being led by a Community Advisory Board as well as community practitioner partners. The community has named the program Tiwahe Wicaghwicayapi (Lakota for: to strengthen/improve families). Native children and/or children living in poverty, ages 10 to 14, will participate in the program with their families. Half of the families will go first and then the second half of the families will get the program after the last survey. The investigators will use surveys to see if and how the program is working and also interview some people who go through the program. A community Advisory Board is involved in all stages of this project and have the ultimate say about how data are shared.

Clinical Trial Description

Research documents the concerning rates and negative outcomes of adverse childhood experiences (ACEs). ACEs include child abuse as well as indicators of household (e.g., exposure to intimate partner violence [IPV]) and neighborhood (e.g., community violence) dysfunction. To date, little is known about two-generation programs that may simultaneously prevent ACEs among children, including IPV in their caregivers.

The purpose of the proposed project is to test the impact of a widely researched alcohol and drug abuse prevention program, the Strengthening Families Program (SFP), on reducing IPV among caregivers, child abuse, and other ACEs among their children (ages 10 to 14). The SFP is for both caregivers and children and consists of parenting skills, children's life skills, and family skills courses taught together in seven 2-hour group sessions preceded by a meal that includes informal family practice time and group leader coaching. Guided by social learning and ecological theories that emphasize the importance of the proximal family environment, the members of this multistakeholder collaborative believe that the SFP has the strong potential to be effective in reducing IPV in caregivers and additional ACEs in their children (e.g., child abuse) given the SFP focuses on reducing myriad risk and protective factors for not only drug use but also for ACEs, including IPV.

To bolster the program's effectiveness, the investigators will adapt the SFP (the adapted program will be called Tiwahe Wicaghwicayapi, Lakota for "to strengthen/improve families") to be culturally relevant given the large presence of American Indians in Rapid City, SD, where the project will take place and to have utility for a broader, diverse audience. Notably, service providers in racially diverse communities frequently do not have the resources to implement various prevention programs. Thus, there is a need in many communities for ACEs prevention programming that is culturally grounded and generalizable to the broader community. The investigators will further enhance the Tiwahe Wicaghwicayapi program to include additional evidence-based IPV prevention strategies (e.g., economic empowerment) for adults and peer-to-peer violence prevention strategies (e.g., bystander intervention) for youth. Specific Aims are as follows:

Adaptation and Planning Aims (Year 1): Convene a Research and Practice Advisory Board that includes elders, practitioners, educators, youth, caregivers, and preventionists (Aim 1a), and conduct focus groups with diverse youth ages 10 to 14 (N = 10), caregivers (N = 10) and professionals (N = 10) in order to culturally tailor the SFP in addition to integrating the IPV prevention components (Aim 1b). Conduct an open pilot trial of the adapted program with 10 families (Aim 1c). Engage youth (N = 10) and caregivers (N = 10) in cognitive testing of survey instruments to be used in the subsequent clinical trial (Aim 1d).

Outcome and Process Evaluation Aims (Years 2 and 3): Following widespread community recruitment, implement and evaluate the feasibility and acceptability of the Tiwahe Wicaghwicayapi program with high-risk families (i.e., American Indian, low income) (Aim 2a). Conduct program observations and fidelity checks (Aim 2b). Gather efficacy data of the Tiwahe Wicaghwicayapi program using a randomized control trial in which eligible families will be randomly assigned to the treatment condition (N = 75 families enrolled) or a wait-list control condition (N = 75 families enrolled), using pre-, immediate post- and 8-month post- follow-up surveys to test for reductions in ACEs (e.g., child abuse) in youth ages 10 to 14 (N = 150 enrolled) and reductions in IPV in caregivers (N = 150 enrolled) for individuals in the treatment group compared to the wait-list control group (Aim 2c). Exploratory analyses will identify mediators (e.g., increases in adult supervision, economic empowerment) and moderators (e.g., gender) of program outcomes (Aim 2d). Conduct exit interview with youth (N = 10), caregivers (N = 10), and program facilitators (N = 10) to gather perceptions of program implementation and impact (Aim 2e). Engage a subset of families (N = 10 youth and N = 10 adults) post-intervention in Photovoice in order to document via photography and group discussions what family strengths look like with a specific focus on what they learned in Tiwahe Wicaghwicayapi program (Aim 2f).

Revision and Dissemination Aims (Year 3): Using data collected as part of Aims 2a to 2f, revise the program and training manuals in anticipation of widespread dissemination to other communities with a large presence of American Indians (Aim 3a). Disseminate the findings and lessons learned to diverse audiences (Aim 3b).

The project is highly significant given the high rates and deleterious outcomes of ACEs in youth including IPV in caregivers. The project is innovative in that the investigators will adapt, implement, and evaluate a highly promising, evidence-based program among a diverse group of high-risk families and use innovative evaluation methodologies (e.g., Photovoice). Finally, the project is feasible given its seasoned team of researchers and project partners, who have a highly successful history of previous collaborations and close attention paid to methodological and programmatic considerations. ;

Related Conditions & MeSH terms

• Adverse Childhood Experiences
• Domestic Violence

• NCT number: NCT05129501
• Study type: Interventional
• Source: University of Nebraska Lincoln
• Status: Completed
• Phase: N/A
• Start date: October 9, 2021
• Completion date: October 31, 2022