A Novel Intervention for System-Involved Intimate Partner Violence Survivors: Changes in Parenting

Abstract

Purpose:

A growing subpopulation of intimate partner violence (IPV) victims comprises mothers who have been mandated to services by either the court system or child protective services (CPS). Two human service agencies in the United States developed a 13-week novel intervention to address these women. All participants were assigned to the intervention, which featured group psychoeducation sessions, social events, and childcare.

Method:

This quasi-experimental study gathered preliminary evidence regarding whether the intervention promoted participants’ (N = 70) parenting practices. Specifically, growth curve analyses using hierarchical linear modeling examined outcomes at completion (3 months) and follow-up (6 months).

Results:

Participants reported statistically significant improvements on key parenting practices at both postintervention time points.

Conclusions:

This study provides preliminary support for engaging court- and CPS-involved female IPV survivors in specialized, group-based interventions such as that investigated herein. Future research should investigate similar programs using larger samples and more robust designs.

Keywords

intimate partner violence court involvement child welfare parenting hierarchical linear modeling

Recent years have witnessed a sharp increase in the populations of a particularly vulnerable subtype of intimate partner violence (IPV) survivor: system-involved women who are simultaneously victims of IPV at the hands of an abusive partner and have also become entangled via arrest or referral with the court system and/or child protective services (CPS).

Arrests of women have risen upward of 35% since the 1980s as they become caught up in widespread proarrest initiatives (DeLeon-Granados, Wells, & Binsbacher, 2006; Klein, 2004; Rajan & McCloskey, 2007). Recent data show that women comprise between 8% and 20% of all IPV arrests (Rajan & McCloskey, 2007). Explanations of this growing trend include a general rise in dual arrests (Hirschel & Buzawa, 2002; Martin, 1997), provocation by the abusive male partner (Stuart, Moore, Hellmuth, Ramsey, & Kahler, 2006), retribution for previous IPV incidents (Hamberger & Potente, 1994), and self-protection and/or defense of a child (A. L. Busch & Rosenberg, 2004; Muftić, Bouffard, & Bouffard, 2007). In addition, 28.5% of CPS-involved children presented with IPV as a caregiver risk factor (U.S. Department of Health and Human Services, 2013). Likewise, research suggests that children who are living in families with IPV are more likely to experience other forms of child maltreatment, including neglect and physical abuse (Hamby, Finkelhor, Turner, & Ormrod, 2010). For these reasons, the child welfare policies of many states consider IPV exposure to be a form of child maltreatment (Moles, 2008). Although some of these system-involved women are, in fact, primary IPV perpetrators themselves, it is much more common that they become system involved in response to victimization by their partners (Rajan & McCloskey, 2007; Simmons, Lehmann, & Collier-Tenison, 2008).

Currently, there is too little evidence to adequately guide service providers and other stakeholders who are faced with difficult task of helping these particular survivors. Being viewed simultaneously as IPV victims, perpetrators, and abusive or neglectful parents places these women in a unique position of being both supported and held accountable for their own IPV victimization. Moreover, the fact that most of them are also mothers of young children, are disproportionately low income, and often face potentially deleterious physical health (e.g., injury) and mental health (e.g., posttraumatic stress) outcomes makes them in a unique subgroup of IPV survivors (Campbell, 2002; Macy, Rizo, Guo, & Ermentrout, 2013). This pilot study aims to help address the gaps in service providers’ understanding and service strategies regarding these women by investigating a community-developed intervention designed to address the distinct needs of these system-involved women. In particular, this examination focuses on changes in the mothers’ parenting over time to gather preliminary evidence whether the intervention can promote positive parenting attitudes and behaviors that can lead to the long-term strengthening of these women and their families.

Characteristics of System-Involved Survivors

Pathways to Involvement

There are two unique pathways by which female IPV victims become system involved. Commonly, these women are arrested either following a domestic disturbance incident during which they sought retribution against their abuser and/or acted in self-defense to protect themselves and their children (A. L. Busch & Rosenberg, 2004; Hamberger & Potente, 1994; Muftić et al., 2007). Although conceptualized by researchers as IPV victims, the legal system unfortunately views these women primarily as IPV perpetrators. Once adjudicated, judges may mandate these women to community services (e.g., batterers intervention program or parenting programs that do not attend to IPV) in lieu of jail time and/or court fines due to them having children in need of care (Simmons, Lehman, & Dia, 2010).

A second pathway to system involvement is through CPS investigations. Increasingly, state governments are adding statutes declaring that exposure to IPV constitutes maltreatment when a child is present and is therefore a crime punishable by CPS and/or the legal system (Moles, 2008). The intentions behind these statutes are likely benevolent and based on strong evidence suggesting that violence exposure in childhood is a risk factor for short- and long-term deleterious outcomes. Unfortunately, the reality is that given the scenario of the victim turned putative perpetrator outlined above, this means that increasing numbers of mothers will become involved with CPS under this framework. Similar to the legal process following arrested, CPS caseworkers’ plans for mothers referred to their services under the guise of child maltreatment often force these women to complete community services in order to maintain or regain custody of their children.

Referral and Treatment

As CPS and the court systems direct abused mothers and their children to services, community-based providers receive these referrals and often struggle to deliver appropriate services to this particularly vulnerable group due to their unique characteristics as well as resource constraints. A key problem is the underlying conceptual framework of most IPV service providers. Typically, community-based IPV services work from the assumption that female survivors are voluntarily seeking help and thus emphasize survivors’ empowerment and choice in decision-making and safety planning (N. B. Busch & Valentine, 2000; Cattaneo & Goodman, 2015). Mothers attending such services are believed to have a certain level of autonomy to attend meetings, access resources, and generally engage with the program. Accordingly, IPV service providers are at a loss with how to address the needs of mandated victims with CPS and court directives. Moreover, CPS and judicial authorities may direct women to community-based services without providing guidance to either women or the providers regarding expected service outcomes. Frequently, system-involved women are directed only to obtain a certificate of completion indicating satisfactory program participation. Little consideration is given to long-term amelioration of IPV exposure or promotion of family well-being. This state of affairs poses serious problems for CPS and criminal justice personnel and for community-based service workers providing treatment.

Researchers have recommended that required services for system-involved women should account for their unique needs both as IPV survivors and as parents (Hamberger & Potente, 1994; Simmons et al., 2008; Stuart et al., 2006). Service providers often find this recommendation difficult to follow. Even in best-case scenarios, survivors may receive evidence-based interventions that attend to their IPV and parenting needs but do not expressly address their experience as mandated clients. Thus, although receiving some level of effective treatment, these women’s unique characteristics are not being acknowledged, with many left feeling frustrated by a system that views them as abusive parents and/or criminals. This gap, ultimately, may undermine intervention effectiveness. More likely, system-involved IPV survivors receive either violence safety or parenting services but not both. Such services are frequently not evidence supported. In worst-case scenarios, some survivors find themselves required to attend batterers intervention programs and/or to spend time in jail.

Challenges to Parenting

A key outcome of interest among system-involved IPV female victims is victimization’s impact on their children and parenting practices. The millions of children who are annually affected by exposure to IPV are likely to suffer from negative impacts to their long-term well-being and development (Evans, Davies, & DiLillo, 2008; Hamby et al., 2010; Roustit et al., 2009; Russell, Springer, & Greenfield, 2010). Due to these overlapping problems, stakeholders have called for the conceptualization, content, and delivery of IPV services to include important considerations for children’s role as IPV victims (Edleson et al., 2007; Simmons et al., 2010). This is especially important for children of system-involved mothers who, due to their mandated status, are likely to face obstacles to parenting (e.g., removal of their children into foster care). However, to date very few IPV interventions that include children specifically target system-involved women (Rizo, Macy, Ermentrout, & Johns, 2011).

Although the evidence concerning IPV victimization and parenting is limited, some research shows that the effect of victimization can harm women’s parenting behaviors and attitudes (e.g., Letourneau, Fedick, & Willms, 2007; Levendosky, Leahy, Bogat, Davidson, & von Eye, 2006). For example, a longitudinal analysis of over 3,245 Canadian mothers found that IPV exposure resulted in decreased levels of positive parenting outcomes such as warmth and positive discipline (Letourneau et al., 2007). Potentially, the emotional, health, and social consequences of victimization together with the unrelenting fear and stress that is often associated with IPV may destabilize women’s positive parenting practices (Lapierre, 2008). Consequently, IPV victimization may reinforce inappropriate parenting behaviors that, in turn, may lead to deleterious outcomes among IPV-exposed children, perpetuating a cycle of victimization and poor development among mothers and children alike. Nonetheless, qualitative research on women’s parenting in the context of IPV found active efforts to mitigate the effect of violence (Levendosky, Lynch, & Graham-Bermann, 2000). Taken together, such research findings suggest that parenting practices are of utmost concern and an important interventions target for system-involved IPV survivors who are parents (Simmons et al., 2010).

Fortunately, there is a small but growing body of literature devoted to investigating parenting services for IPV survivors. Among studies using the most rigorous designs (i.e., randomization) to investigate programs designed to ameliorate the parenting and well-being of IPV survivors who are mothers, findings show promise (Basu, Malone, Levendosky, & Dubay, 2009; Jouriles et al., 2001, 2009; McDonald, Jouriles, & Skoop, 2006; McWhirter, 2011; C. M. Sullivan, Bybee, & Allen, 2002). These studies investigated both group interventions (Basu et al., 2009; McWhirter, 2011) and home-visiting interventions (Jouriles et al., 2001, 2009; McDonald et al., 2006; C. M. Sullivan et al., 2002). Among these studies, intervention content and goals included providing social support for mothers, improving the mother–child relationship, enhancing women’s coping and problem-solving skills, and enhancing parenting knowledge and skills. Although the growing attention to investigating such programs is notable, the number of studies on this topic is limited. Thus, this research does not yet clearly indicate what components, content, and delivery methods are most effective for meeting the needs of mothering IPV survivors. Furthermore, there is limited attention in this research to the unique characteristics or outcomes of system-involved survivors, particularly among survivors who are involved with the criminal justice system (Rizo et al., 2011; Simmons et al., 2010).

The Mothers Overcoming Violence Through Education and Empowerment (MOVE) program

About 10 years ago, two community-based nonprofit agencies in North Carolina simultaneously noticed that there were striking increases in numbers of referrals of system-involved IPV women to their services. Although one agency was concerned with supporting victims of domestic violence (InterActy) and the other was focused on preventing child abuse (SAFEchild), the two realized that their efforts dovetailed and that successful support for these unique women and their children necessitated the development of a novel intervention approach. After partnering with local researchers, the agencies colead an initiative to (a) identify the needs of the women mandated to their services, (b) develop a comprehensive group program to support the women and their children, and (c) create strategies for the delivery and assessment of the new program. The result of this initiative, the MOVE program, debuted in 2007 as a singular intervention developed by the agencies based on their experiences working with IPV-exposed families, their professional expertise in their respective areas, and existing parenting curricula developed for other IPV-involved families (e.g., Turner, Gilbert, Hendricks, & Demaree, 2006).

Briefly, MOVE is a 13-week program serving approximately 50 families each year. Participation is based on three eligibility criteria: (a) having been mandated by county court and/or CPS; (b) identifying as the biological mother, adoptive mother, foster mother, or stepmother to a child or acting as the primary caregiver to a related or nonrelated child; and (c) having been screened positively for past or present IPV victimization. Program eligibility is determined at intake through a comprehensive biopsychosocial assessment interview conducted by a master’s-level social worker with professional experience in the area of family violence. Once enrolled, participants meet together one evening a week at the location of one of the participating agencies for 90–120 min. The program is comprised of two main components: (a) a psychoeducational, therapeutic parenting group for the mothers and (b) a concurrent therapeutic support group for their children. The groups meet simultaneously in separate rooms. Beyond the group meetings, MOVE also offers dinner for the families, transportation if needed, childcare for children under the age of 5, and security services to ensure staff and participant safety. These program amenities are used to help facilitate participation and provide a safe environment for families.

Conceptually, MOVE was created based on the principle that female IPV survivors should be treated equally without regard to IPV perpetration. Thus, the program is grounded in the empowerment philosophy that is frequently used in the delivery of IPV services for victims. In practice, the program emphasizes women’s strengths by encouraging participants’ self-assessment of their skills and resources as well as encouraging women to serve as role models for their group peers. While the service providers actively address the women’s system involvement during program delivery, the providers’ approach to service delivery is positive and supportive as well as nonjudgmental and nonpunitive. MOVE is also guided by Bandura’s (1991) social cognitive theory. Informed by this theory, the program aims to ensure that participants possess the three requirements for change specified by the theory: (a) behavioral capability, (b) expectations, and (c), self-efficacy. The service providers also use social cognitive intervention strategies such as modeling and reinforcements to facilitate participants’ learning. For example, the service providers mail participants notes of encouragement and progress certificates throughout the 13-week group. Such tokens both reinforce participants’ progress and model supportive behaviors.

The service providers determined that the program should be delivered using a group modality to help foster support and peer learning among the participants. The service providers also determined that the mothers’ program content should focus on healthy families, safety planning, child development, communication, anger management, positive discipline, effects of IPV on children, talking to children about violence, and self-esteem. By focusing the program content on practical topics that are relevant for women’s lives, as well as skill development in critical areas to help women parent in the context of ongoing IPV, the program aims to help improve women’s parenting, mental health, well-being, and their families’ safety through reductions in IPV.

In addition, through meetings, coordination, and ongoing communication with the community’s CPS agency leadership and frontline staff, as well as with the community’s district attorneys and judges, the MOVE service providers work to embed the program as the main community response option for system-involved IPV survivors. Through these efforts, the service providers help to ensure that such survivors are directed to their program rather than to other venues (e.g., batterer intervention programs, jail).

Current Study

Prior quantitative and qualitative results on MOVE have shown encouraging results regarding a number of important outcomes for system-involved IPV female victims, such as IPV victimization and perpetration. Extant research has not, however, examined whether the MOVE program may be promotive of positive parenting. The current study now investigates these parenting outcomes that are crucial to mother–child dyad functioning and well-being. Specifically, this exploratory study aimed to gather preliminary evidence regarding whether the program seemed promising and warranted further evaluation with larger, more rigorous methods. Given the dearth of intervention research focused on system-involved survivors (Rizo et al., 2011; Stover, Meadows, & Kaufman, 2009), this study also aimed to investigate the acceptability and feasibility of the research methods. The study featured one explicit research question: Relative to program entry, do system-involved female IPV survivors who participated in MOVE report statistically significant improvements in positive parenting outcomes at (a) program completion (3 months) and (b) follow-up (6 months)?

Method

This research was conducted in collaboration with the two community agencies that developed and implemented MOVE. All study methods were reviewed and approved by the institutional review board at the University of North Carolina at Chapel Hill. In light of the research participants’ unique vulnerabilities, a National Institute of Health Certification of Confidentiality was also obtained.

Participants

Following court and/or CPS referral, all IPV survivors who enrolled in the MOVE between January 2009 and July 2011 were eligible to participate and were recruited to be in the study. During this time, the intervention was delivered to 10 cohorts of women comprising a total of 89 women. Because of a dearth of uniform reporting within courts and CPS, it is unknown to what extent these women were representative of the national population of system-involved women. Of these 89 women, 73 (82.0%) agreed to participate in the present study. Subsequently, one woman did not start the program and two women missed three or more sessions. Thus, the data presented herein are based on a convenience sample of the 70 women (78.7%) who met the inclusion criteria of having completed the program (i.e., having missed less than three sessions). Independent t tests comparing women who did and did not complete MOVE found that women who did not complete the program (n = 3) reported having more children (M = 2.00, standard deviation [SD] = 0.00) compared with those who completed (M = 1.60, SD = 1.12), t(69) = 2.98, p < .05. No other differences were found on demographic covariates in the data. A calculation of the effect size (ES) using Hedge’s g due to the small sample size found a moderate effect for having children on program completion (ES = .36).

Procedures

MOVE implementation

In partnership, the research team and the providers developed the MOVE program manual based on Carroll and Nuro’s (2002) stage model for developing manuals as well as empirical findings from prior evaluations of the MOVE program’s feasibility and acceptability. The manual incorporates information on the program’s (a) rationale and goals, (b) conceptual framework, (c) change processes and essential elements, (d) intervention strategies, (e) sessions’ formatting including detailed guidance, (f) solutions for service delivery challenges, and (g) implementation checklist forms to monitor and ensure implementation fidelity. MOVE providers then used the manual and implementation forms to ensure that the program was consistently delivered across all groups and providers throughout the study. Over the course of the study, MOVE group meetings, in which six to nine program participants met one evening per week, were coled by two service providers from the community-based agencies that developed the program. One service provider had primary responsibility for developing, staffing, and delivering the program and trained all MOVE service providers (n = 7). Program fidelity was ensured in three primary ways: (a) use of a detailed manual to guide providers’ program delivery; (b) consistent training of all MOVE providers by the primary program developer; and (c) implementation of checklist forms to monitor and ensure consistent program delivery across groups, meetings, and providers.

Study recruitment and data collection

The women were first provided an overview of the research at program intake and informed that participation would include the completion of questionnaires at 3 times: (a) program entry (0 months), (b) program completion (3 months), and (c) follow-up (6 months). Although all participants were mandated to services at one of the two community organizations, women were not required to participate in the study. After providing informed consent, participants completed a packet of self-report inventories at one of the agencies that included demographic questions as well as standardized measures for all program outcomes. Depending on participants’ literacy, the questions were either self-administered or read aloud by a research team member. To reduce participation burden, transportation and childcare were offered to participants who met with research team members to complete questionnaires. Postage and mailing materials were provided to participants who preferred to mail their completed questionnaires. All participants received a discount store gift card as acknowledgment for completing the inventories at each time.

Measurements

The study used two measures to examine potential improvements to reported parenting practices. Although both measures arose out of the need to protect and prevent child abuse and maltreatment, the two surveys frame parenting from the distinct viewpoints of a deficit focus and a strengths-based focus, respectively. It was determined that using both sets of measures conjointly would provide a more robust picture of participants’ parenting than merely using one.

Risky parenting

Parenting practices were first assessed using the Adult-Adolescent Parenting Inventory (AAPI), a 32-item survey comprising four subscales measuring risky parenting practices (Bavolek, 1984). The AAPI has generally demonstrated acceptable reliability and validity across various psychometric evaluations and has been widely used in research to assess problematic parenting behaviors among a variety of settings and parent–child dyads (e.g., Bavolek, 1984; Gorzka, 1999; Lutenbacher, 2001). All 32 AAPI items were rated on 5-point Likert-type scales ranging from strongly agree (1) to strongly disagree (5). The first AAPI subscale, Role Reversal, comprised 8 items measuring parents’ inappropriate desires to use their children to satisfy their needs. The items assessed unhealthy reversing of traditional roles such that the child assumes the role of the parent who, in turn, takes on the role of a needy child (e.g., “Children should be the main source of comfort and care for their parents”). Scores for Role Reversal ranged from 8 to 40 and Cronbach’s α in the sample was .94. The Lack of Empathy subscale comprised 8 items measuring the ability of parents to identify and empathize with their children. The items assessed whether parents had low levels of empathy for their children’s needs and feelings, which could translate into viewing children’s actions as irritating or troublemaking (e.g., “Parents who are sensitive to their children’s feelings and moods often spoil their children”). Scores for Lack of Empathy ranged from 8 to 40 (α = .95). The Inappropriate Expectations subscale comprised 6 items measuring parents’ realistic expectations of their children relative to their growth and development. The items assessed whether parents might inaccurately perceive, and act upon, their children’s skills and abilities to be greater than reality (e.g., “Children should be expected to verbally express themselves before the age of 1 year”). Inappropriate Expectations items ranged from 6 to 30 (α = .94). Lastly, the Corporal Punishment subscale comprised 10 items measuring parents’ attitudes toward the use of potentially abusive corporal punishment techniques. The items assessed whether parents’ disciplinary ideals might cause them to physically abuse their children under the goal of promoting character and values (e.g., “Children learn good behavior through the use of physical punishment”). Corporal Punishment scores ranged from 10 to 50 (α = .94). Because the AAPI items are negatively coded, higher scores on the AAPI are indicative of more positive parenting and child-rearing practices. Participation in the MOVE program was hypothesized to be associated with ameliorations in risky parenting and, thus, increases in AAPI scores.

Healthy parenting

Parents’ individual functioning and healthy parenting behaviors were also measured using the Healthy Families Parenting Inventory (HFPI), a 63-item assessment comprising nine subscales that has demonstrated good reliability and validity (Krysik & LeCroy, 2012) and has been widely used to assess parenting across diverse settings (e.g., Krysik & LeCroy, 2007). All 63 HFPI items are rated on 5-point Likert-type scales ranging from rarely or never (1) to always or most of the time (5). The first HFPI subscale, Social Support, comprised 5 items assessing parents’ individual feelings of having sufficient social support (e.g., “I feel that others care about me”; range = 5–25; α = .90). The Personal Care subscale comprised 5 items assessing parents’ individual capacity to care for themselves (e.g., “I take time for myself”; range = 5–25; α = .81). The Problem-Solving subscale comprised 6 items assessing parents’ ability to solve their individual problems (e.g., “When I have a problem, I take steps to solve it”; range = 6–30; α = .87). The Mobilizing Resources subscale comprised 6 items assessing parents’ ability to locate and procure resources for themselves and their family (e.g., “I know where to find resources for my family”; range = 6–30; α = .83). The Role Satisfaction subscale comprised 6 items assessing parents’ individual feelings of satisfaction with their roles as parents (e.g., “I feel drained dealing with my child”; range = 6–30; α = .86). The Parenting Efficacy subscale comprised 6 items assessing parents’ individual valuation of their efficacy as a parent within their family (e.g., “I am proud of myself as a parent”; range = 6–30; α = .89). The Depression subscale comprised 9 items assessing parents’ individual feelings related to depressive symptoms (e.g., “I feel unhappy about everything”; range = 9–45; α = .89). The Parent/Child Interactions subscale comprised 10 items assessing whether parents feel positive about their daily interactions with children (e.g., “I respond quickly to my child’s needs”; range = 10–50; α = .76). The Home Environment subscale comprised 10 items assessing whether the parent is able to create a positive and healthy home environment to promote children’s growth (e.g., “I have organized my home for raising a child”; range = 10–50; α = .84). Several of the subscales had items that were negatively coded on the original survey administered to participants. These items were reverse coded, so that higher HFPI scores were indicative of positive parenting attitudes and practices. Participation in MOVE was hypothesized to enhance positive parenting and, thus, be associated with increases in the HFPI items.

Covariates

The evaluation of MOVE included 13 covariates to control for extraneous, confounding factors that could potentially overestimate the effects on the parenting outcomes. Age in years was measured as a continuous variable ranging from 20 to 51. Education level was assessed with two dichotomous variables representing (a) attainment of some college/technical education and (b) attainment of some graduate education (1 = yes, reference = high school (HS)/general educational development (GED) degree or below). Income source was measured with two dichotomous variables representing (a) receipt of government assistance and (b) other source of income (1 = yes, reference = personal employment). Number of children was measured using two count variables representing (a) the total number of children currently living with the participant (range = 0–9) and (b) children aged 5 or under (range = 0–3). Race/ethnicity was measured as a dichotomous variable that grouped participants as either African American (1 = yes) or Other (0 = no; e.g., European American, Latina, and Asian American). Employment status was measured using two dichotomous variables representing (a) part time and (b) unemployed/homemaker (1 = yes, reference = full time). Referral source was measured using two dichotomous variables representing referral via (a) CPS only or (b) court only (1 = yes, reference = both). Relationship with abuser was measured as a time-varying covariate reflecting whether survivors remained actively partnered with the abusive partner that led to their involvement with MOVE at each of the three data collection time points (1 = yes, reference = no).

Analytic Plan

Evaluation design

The analytic goal of the study was to gather preliminary evidence regarding MOVE’s potential to positively influence participants’ parenting-related change trajectories. As is commonplace for evaluations of interventions within social–behavioral settings, this pilot study employed a quasi-experimental design. Although a randomized trial is the gold standard in program evaluation, it is often infeasible and unethical to use in studies such as the current one given the lack of resources and time of the community organizations and the vulnerability of the participants. When applicable, the study adhered to the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) checklist (Des Jarlais, Lyles, & Crepaz, 2004).

The following equation represents the evaluation design:

O_{1} X O_{2} O_{3},

where O ₁ represents the baseline data collection (time = 0 months), X indicates the MOVE intervention (13 weeks), O ₂ represents data collection at postintervention (time = 3 months), and O ₃ represents a data collection at follow-up (time = 6 months). Thus, the participants’ program entry data serve as their own comparison, with a participant’s outcomes at postintervention points (i.e., O ₂ or O ₃) being compared with the same outcome at program entry (i.e., O ₁). If the program is successful, it is expected to see statistically significant (p < .05) and positive (+) changes in parenting outcomes for participants. It should be noted that this quasi-experimental design inherently has lower internal validity than an randomized control trial. This is a reflection of the preliminary nature of this study but is an important limitation of the findings.

Analytic model

The specific analytical model was a growth curve analysis using hierarchical linear modeling (HLM; Raudenbush & Bryk, 2002) conducted in Stata Version 10.0 (StataCorp). Comparing with conventional multivariate models, HLM offers the key advantages of being able to (a) control for clustering effects, (b) employ data from participants at all available time points, and (c) incorporate time-varying covariates into the analysis (Guo, 2005; Raudenbush & Bryk, 2002). The specific analytic HLM equation for this study is as follows:

Level 1:

Y_{t i} = π_{0 i} + π_{1 i} (T i m e) + π_{2 i} (P o s t) + π_{3 i} (R e l a t i o n) .

Level 2:

\begin{array}{l} π_{0 i} = β_{00} + \sum_{q = 1}^{Q} β_{0 q} X_{q i} + r_{0 i}, \\ π_{1 i} = β_{10}, \\ π_{2 i} = β_{20} + r_{2 i}, \\ π_{3 i} = β_{30} . \end{array}

Combined:

Y_{i t} = β_{00} + \sum_{q = 1}^{Q} β_{0 q} X_{q i} + β_{10} {(T i m e)}_{t i} + β_{20} {(Post)}_{t i} + β_{30} {(Re l a t i o n)}_{t i} + r_{0 i} + r_{2 i} {(P o s t)}_{t i} + e_{t i} .

where Y_ti is the outcome Y at time t for participant i, Time is the time variable in months and represents the three data collection time points, Post is a dichotomous variable to indicate a postintervention time point (1 = O ₂ or O ₃, 0 = O ₁), Relation is a time-varying covariate measuring the participant’s relationship with her abusive partner, and X_qi are Q covariates of the study participants (n = 11). Using this setup, the coefficient β₂₀ (i.e., postintervention) serves as the primary variable of interest for evaluation purposes. Whether or not this coefficient is (a) statistically significant and (b) positive determines the existence of a practically beneficial treatment effect on participants’ parenting behaviors. Coefficients r ₀ and r ₂ comprise the random effects of the model. They represent extra heterogeneity associated with the model intercept and slope of Post, respectively, and are included to control for clustering effects. Using a full maximum likelihood estimator, likelihood ratio tests were used to determine whether or not r ₂ should be included in the model. Following HLM convention (Raudenbush & Bryk, 2002), the final HLM models employed a restricted maximum likelihood estimator.

Diagnostic checks

Analyses were conducted on the treated and not with intent to treat. Study protocols resulted in retention rates of 98.6% (n = 69) at program completion and 84.3% (n = 59) at the follow-up. Bivariate analyses examining differences between the women who did and did not complete follow-up data found no statistically significant differences based on demographic characteristics (p > .05). There were no missing data for the measures used in the current study, and no corrections were made for missingness.

All possible clustering effects in the data were checked with diagnostic procedures. In addition to the nesting of data collection time points within participants, MOVE is a group intervention whereby study participants were exposed to the program in treatment cohorts. Thus, intraclass correlation coefficients (ICCs) were computed for all parenting outcome variables using participants’ treatment cohort as a clustering factor. Results found that all ICCs were zero or close to zero (see Table 1). Therefore, it was concluded that participants’ cohort grouping did not add clustering effects that warranted control in the analysis. Thus, the HLM analysis shown in the above equations uses a two-level model (i.e., time and participant levels) and one or two random effects (r ₀, or r ₀ and r ₂) to control for clustering effects related to the nesting of data collection time points within participants.

Table 1.

Parenting Descriptive Statistics.

Outcome	Baseline			Postintervention		Follow-Up
Outcome	ICC	N	M (SD)	N	M (SD)	N	M (SD)
Parenting: Adult-Adolescent Parenting Inventory
Role Reversal	.00	67	32.81 (6.02)	67	34.82 (6.03)	54	35.72 (5.44)
Lack of Empathy	.00	67	33.82 (4.98)	67	34.78 (5.04)	54	35.17 (4.70)
Inappropriate Expectations	.00	67	26.39 (3.10)	67	27.01 (3.21)	55	27.11 (3.24)
Corporal Punishment	.00	67	40.81 (6.49)	67	42.45 (6.73)	53	42.75 (6.42)
Parenting: Healthy Families Parenting Inventory
Social Support	.03	68	18.15 (5.32)	68	19.29 (5.46)	57	18.53 (5.57)
Personal Care	.00	68	18.37 (4.33)	67	19.70 (4.42)	56	19.80 (4.05)
Problem-Solving	.00	67	20.49 (5.01)	68	22.56 (5.14)	57	23.11 (4.85)
Mobilizing Resources	.00	66	20.94 (6.04)	64	22.52 (5.23)	53	23.34 (4.81)
Role Satisfaction	.00	67	23.21 (5.43)	67	25.16 (4.81)	55	25.45 (4.32)
Parenting Efficacy	.00	66	24.73 (4.28)	67	26.36 (3.79)	55	25.80 (4.77)
Depression	.00	67	34.04 (7.52)	68	36.74 (7.50)	56	37.55 (7.49)
Parent/Child Interactions	.00	65	43.71 (4.83)	67	43.78 (6.12)	55	43.56 (6.06)
Home Environment	.00	67	42.04 (6.04)	67	43.84 (5.66)	53	43.04 (6.42)

Note. ICC = Intraclass correlation coefficient with cohort as the grouping variable; SD = standard deviation.

As a small, pilot study, the analysis likely lacked sufficient statistical power to detect statistically significant changes in the parenting outcomes using commonplace power analysis metrics. That said, the analysis was conducted due to the desire to gather important preliminary evidence regarding the efficacy of MOVE. The lack of power was determined to be detrimental to the analysis only if no significant associations were found for postintervention. The included covariates were employed for methodological reasons and were not of substantive interest in the present study. To aid in overcoming issues of statistical power, the analysis (a) used one-tailed tests for the key Postintervention variable of interest and (b) reported values approaching statistical significance (p < .10) when present.

Results

Univariate Sample Characteristics

Almost half of the sample (n = 33, 47.1%) was solely court mandated to services, whereas 20% (n = 14) was solely CPS mandated to services. About a third of the sample (n = 23, 32.9%) were involved in both systems. Participants’ ages ranged from 20 to 51 years old (M = 30.9). Most women identified their race/ethnicity as African American (n = 37, 52.9%), followed by European American (n = 22, 31.4%), multiracial (n = 7, 10%), and Other (n = 4, 5.7%). Nearly 70% of participants reported having completed some post-HS coursework or having obtained diplomas at the undergraduate and/or graduate levels. Over a third of participants (n = 29, 41.4%) reported working full time, with nearly 20% working part time (n = 13, 18.6%) and 40% being unemployed or homemakers (n = 28). About 44% (n = 30) received income through their own personal employment, with 12% (n = 8) receiving government assistance and 44% (n = 30) having other sources of income. Two women were primary caregivers for their male partners’ children, with all other participants being mothers. The mean total number of children living either in or out of participants’ homes was 2.53 (SD = 1.66, range = 0–9) and the mean of children aged 5 or under was 1.04 (SD = 0.73, range = 0–3). At program entry, 42% of the participants were in a relationship with their abuser, decreasing to about 32% at 3 months upon program completion and 19% at the follow-up, about 3 months after program completion and 6 months from program entry.

Growth Curve Analyses of AAPI Outcomes

Wald χ² tests were conducted to test the model fit of the HLM models for each of the AAPI parenting outcomes (see Table 2). Despite the small sample size, the results for three AAPI models demonstrated statistical significance (p < .05) or a trend toward statistical significance (p < .10) indicating acceptable fit to the data: (a) Lack of Empathy, (b) Corporal Punishment, and (c) Role Reversal. The model for Inappropriate Expectations was not statistically significant.

Table 2.

Estimated Hierarchical Linear Modeling Models for Adult-Adolescent Parenting Inventory Outcomes.

Effects	Role Reversal	Lack of Empathy	Corporal Punishment
Fixed effects
Number of months since baseline	0.089	0.064	−0.129
Postintervention (preintervention)	1.671^†	0.803	1.985*
Age	−0.236*	−0.150	−0.162
Education level (≤HS/GED)
College/technical	2.707^†	2.171	1.101
Graduate	9.114***	4.542*	5.687*
Income source (personal employment)
Government assistance	1.215	1.349	−1.106
Other	1.584	0.501	−0.756
Total number of children	0.677	0.002	0.055
Children aged 5 or under	−0.764	−1.049	−0.377
African American (Other)	−3.242*	−2.341^†	−3.348*
Employment status (full time)
Part time	−0.965	0.328	1.522
Unemployed/homemaker	−0.252	−1.479	−0.230
Referral source (both)
CPS only	3.174	−0.133	3.062
Court only	1.308	−1.677	−1.406
Relationship with abuser (no)	−0.838	0.429	−0.487
Constant	37.034***	39.556***	46.841***
Random effect
Intercept	19.364	16.348	27.412
Observations	188	188	187
Participants	67	67	67
Wald χ² (df)	41.34 (15)***	23.64 (15)^†	22.31 (15)^†

Note. Reference groups are in parentheses. CPS = child protective services; HS = high school.

*p < .05. ***p < .01. ^† p < .10 (one-tailed test for postintervention; two-tailed test for all other variables).

The Role Reversal model was statistically significant indicating good fit to the data: χ²(15, N = 188) = 41.34, p < .001. The Postintervention variable demonstrated a statistical trend with scores at either time postintervention being 1.67 units higher than at program entry (p < .10; ES_Post = .33, ES_follow-up = .50). The Lack of Empathy model demonstrated a statistical trend, χ²(15, N = 188) = 23.64, p < .10, but the Postintervention variable was not statistically significant. Lastly, the Corporal Punishment model demonstrated a statistical trend, χ²(15, N = 187) = 22.31, p < .10, and the Postintervention variable was statistically significant with scores at either postintervention time being 1.99 units higher than at program entry (p < .05; ES_Post = .27, ES_follow-up = .30). The change trajectories for the AAPI parenting outcomes were also plotted (not pictured). The mean-change trajectory graph for Corporal Punishment was significant (p < .05) and showed an increase from program entry to postintervention but a slight decrease at the 6-month follow-up. The mean-change trajectory graph for Role Reversal demonstrated a trend (p < .10) and showed continued increases at both postintervention and follow-up. Overall, findings show that parenting scores increased by 8.9% for Role Reversal (ΔM = 2.91), 4.0% for Lack of Empathy (ΔM = 1.35), and 4.8% for Corporal Punishment (ΔM = 2.91) from baseline to follow-up.

Growth Curve Analyses of HFPI Outcomes

Wald χ² tests were also conducted to test the model fit for each of the HFPI parenting outcomes (see Table 3). Of the nine HFPI subscales, seven parenting outcomes were found to be statistically significant (p < .05): (a) Personal Care, (b) Problem-Solving, (c) Mobilizing Resources, (d) Role Satisfaction, (e) Parenting Efficacy, (f) Depression, and (g) Home Environment. The models for Social Support and Parent/Child Interactions were not statistically significant.

Table 3.

Estimated Hierarchical Linear Modeling Models for Healthy Families Parenting Inventory Outcomes.

Effects	Personal Care	Problem- Solving	Mobilizing Resources	Role Satisfaction	Parenting Efficacy	Depression	Home Environment
Fixed effects
Number of months since baseline	0.030	0.178	0.042	−0.006	−0.200	0.258	−0.226
Postintervention (preintervention)	1.229^†	1.612^†	1.247	1.842*	2.396**	1.916	2.505**
Age	0.156*	0.100	0.187^†	0.209*	−0.078	0.146	0.110
Education level (≤HS/GED)
College/technical	−1.052	1.282	−0.125	−0.889	−1.347	−0.006	−1.689
Graduate	−5.372**	−1.384	−1.301	−7.183***	−3.420^†	−7.484*	−5.579*
Income sources (personal employment)
Government assistance	0.812	0.226	2.518	−0.412	−1.753	1.815	1.351
Other	0.407	−1.581	0.085	−1.025	−1.004	−0.413	−0.194
Total number of children	−1.181*	−0.300	−0.840	−0.884^†	−0.658	0.105	−1.866*
Children aged 5 or under	−0.228	−0.026	1.776^†	1.142	−1.419^†	−0.442	0.939
African American (Other)	1.246	−1.015	−2.221^†	−1.732^†	1.549	0.563	−1.832
Employment status (full time)
Part time	−0.500	0.606	−0.013	−0.078	0.491	0.901	−0.030
Unemployed/homemaker	−0.973	0.125	−1.716	−2.131	0.322	−0.594	−3.269
Referral source (both)
CPS only	−1.071	2.463	0.488	−0.685	−0.074	1.415	−4.147*
Court only	−0.167	−0.255	−0.512	−0.793	−0.592	1.393	−0.708
Relationship with abuser (no)	−1.150^†	0.670	−1.599^†	−1.473*	0.527	−0.757	0.398
Constant	17.45***	17.79***	17.38***	22.01***	30.57***	29.99***	45.68***
Random effects
Intercept	9.102	12.164	18.226	21.761	10.670	30.789	25.372
Slope postintervention				12.443			12.854
Observations	191	192	183	189	188	191	187
Participants	68	68	68	67	67	68	67
Wald χ² (df)	37.94 (15)***	34.69 (15)**	25.58 (15)*	55.50 (15)***	29.49 (15)*	31.28 (15)**	27.18 (15)*

Note. Reference groups are in parentheses. CPS = child protective services; HS = high school.

*p < .05. ***p < .01. ^† p < .10 (one-tailed test for postintervention; two-tailed test for all other variables).

The Personal Care model was statistically significant indicating good fit to the data: χ²(15, N = 191) = 37.94, p < .001. The Postintervention variable demonstrated a statistical trend such that the mean at any time postintervention was 1.23 units higher than at program entry (p < .10; ES_Post = .21, ES_follow-up = .07). The Problem-Solving model was statistically significant, χ²(15, N = 192) = 34.69, p < .01, and the Postintervention variable demonstrated a statistical trend with the mean score at any postintervention time point being 1.61 units higher than at baseline (p < .10; ES_Post = .41, ES_follow-up = .53). The Mobilizing Resources model was statistically significant, χ²(15, N = 183) = 25.58, p < .05, but the Postintervention variable was not. The Role Satisfaction model was statistically significant, χ²(15, N = 189) = 55.50, p < .001, and the Postintervention variable indicated that the mean for scores at any time postintervention was 1.84 units higher than at program entry (p < .05; ES_Post = .38, ES_follow-up = .45). The Parenting Efficacy model was statistically significant, χ²(15, N = 188) = 29.49, p < .05, and the Postintervention variable indicted that the mean postintervention was 2.40 units higher than at baseline (p < .01; ES_Post = .40, ES_follow-up = .24). The Depression model was statistically significant, χ² (15, N = 191) = 31.28, p < .01, but the Postintervention variable was not. Lastly, the Home Environment model was statistically significant, χ²(15, N = 187) = 27.18, p < .05, and the statistically significant Postintervention variable found that the mean at any postintervention time point was 2.51 units higher than at program entry (p < .01; ES_Post = .31, ES_follow-up = .16). The change trajectories for the HFPI parenting outcomes were also plotted (not pictured). The mean-change trajectory graphs for Role Satisfaction (p < .05), Parenting Efficacy (p < .01), and Home Environment (p < .01) were statistically significant but showed either decreases or leveling off at follow-up. Meanwhile, the trajectories for Personal Care and Problem-Solving demonstrated a statistical trend (p < .10) and showed continued increases from postintervention to follow-up. Overall, findings show that from baseline to follow-up, the intervention increased HFPI parenting scores by 7.8% for Personal Care (ΔM = 1.43), 12.8% for Problem-Solving (ΔM = 2.62), 11.5% for Mobilizing Resources (ΔM = 2.40), 9.7% for Role Satisfaction (ΔM = 2.24), 4.3% for Parenting Efficacy (ΔM = 1.07), 10.3% for Depression (ΔM = 3.51), and 2.4% for Home Environment (ΔM = 1.00).

Covariates

Across the 10 models that demonstrated good fit to the data, none of the 13 covariates were consistent predictors of AAPI or HFPI outcomes and only 8 demonstrated any statistically significant or approaching significant associations with the parenting outcomes. Graduate education level attainment approached or reached statistical significance in 8 of the 10 models. It displayed contradicting trends depending on the survey, being positively associated with all three AAPI models but negatively associated with five of the HFPI models. The reason for this anomaly is uncertain. Similarly, increases in age were negatively associated with AAPI’s Role Reversal but positively associated with three of the HFPI models. The only other covariate that demonstrated an apparent trend was African American race, which was negatively associated with increased parenting scores. Other covariates that were found to be intermittently significant in the 10 models included college/technical education level, total number of children, children aged 5 or under, CPS only referral, and relationship with abuser. The general lack of significance of many of the covariates across the models is not detrimental to the research goals as the key aim of the study was to determine statistical significance of the Postintervention variable. Also, a larger sample size would have increased statistical power and, thus, would likely have improved the models’ ability to demonstrate statistical significance.

Discussion

This analysis used sophisticated growth curve HLM to examine the effect of a community-based group intervention on parenting outcomes among 70 IPV female victims mandated to services. The study featured a quasi-experimental design and attempted to develop preliminary evidence regarding whether MOVE might be effective for the unique population of system-involved mothers who have experienced IPV victimization and by extension whether other stakeholders in other settings working with similar women should consider adopting similar strategies.

Results conditionally supported this assertion, with the research question being answered affirmatively for 7 of the 13 parenting outcomes at either postintervention or follow-up. Based on best available evidence, it appears that for the 70 system-involved IPV victims in the study, participation in the MOVE program fostered more positive parenting attitudes that could lead to more appropriate parenting practices. Notably, findings showed statistically significant decreases in attitudes that are supportive of corporal punishment, along with improvements in parental role satisfaction, parental efficacy, and home environments. The findings also demonstrated positive statistical trends in participants’ capacity for problem-solving and personal care as well decreased tendencies toward parent–child role reversal.

Such parenting improvements may also enhance participants’ efforts to mitigate the deleterious effects of IPV exposure on their children’s development. Resilient IPV-exposed children have mothers with strongly positive parenting practices such as appropriate disciplinary methods, parental warmth, and appropriate limit setting (Graham-Bermann, DeVoe, Mattis, Lynch, & Thomas, 2006). Accordingly, the parenting improvements determined in this study, especially in the areas of corporal punishment and parental efficacy, may signal the potential value of MOVE toward promoting child resilience to IPV exposure.

This study had numerous strengths that make it a valuable addition to social work research and practice. These included (a) a focus on a unique and understudied problem and population of direct interest to social work, (b) robust participant recruitment and retention, (c) attention to multiple outcome domains based on best available evidence, (d) the use of advanced multilevel analyses that appropriately accounted for the substantive and statistical challenges posed by clustered data, and (f) a collaborative partnership between providers and researchers that resulted in findings with strong ecological validity due to the study being conducted in a community-based setting with service providers developing and delivering the program.

Limitations

The results of the study are limited primarily by its design and sample. The study’s quasi-experimental design featured lower internal validity than a randomized design (Shadish, Cook, & Campbell, 2002), meaning that the positive increases in parenting outcomes could be due to unmeasured and unseen variables that influenced women and not wholly or even partially due to participation in MOVE. Also, the design although longitudinal did not assess for parenting outcomes prior to program entry or at extended time periods postintervention. The decreases seen in the change trajectories at the follow-up compared with immediately after the intervention suggest that there may be a need for additional booster sessions to encourage lasting changes in mothers’ parenting practices. Also, having more measurement points would provide more validity to the study’s promising findings. The study’s sample, while comprehensive for the community in which the program and agencies existed, was small and gathered by convenience. Thus, it is undetermined how generalizable the sample women included in this study are to the greater population of system-involved IPV victims in the United States. Also, as mentioned above, the sample was very likely underpowered to detect all significant effects. Increasing the sample size is particularly important for inquiries investigating the substantive meaning of potentially significant covariates and should be a key goal for future research on MOVE. There are also smaller limitations with the measurements, particularly the self-report nature of the AAPI and HFPI measures and the inability of the data to account for other potential confounders beyond the demographic covariates included. Evidence also exists indicating that the AAPI may be lacking in validity for low-income parents (Lawson, Alameda-Lawson, & Byrnes, 2015) and that the more recent revised AAPI-2 may be preferable to the older version used herein (Conners, Whiteside-Mansell, Deere, Ledet, & Edwards, 2006). More broadly from an applicability and generalizability standpoint, MOVE is a unique program involving two particular organizations that may not be replicable in other settings. It is unknown whether the program outlined and tested herein would be able to be implemented by other agencies in other locations.

Implications

In light of the potentially promising findings determined here, courts and CPS agencies are encouraged to consider programs and practices in line with those offered by MOVE for system-involved IPV survivors. Other programs for system-involved IPV survivors may consider aiming to help improve women’s parenting as well as their families’ safety. Using a group modality, programs could aim to address women’s system involvement through a supportive and nonpunitive service delivery approach by using an empowering program philosophy and strategies informed by social cognitive theory. Study findings also suggest the value of program content on topics that are relevant for IPV survivors’ lives and on skill development to help survivors parent in the context of ongoing IPV. Programs might also consider including program amenities (i.e., meals, security, childcare, and transportation) to help families attend and fully participate. Concurrent with the shift in how entrenched systems manage IPV survivors, there should also be the continued recognition that these women are not homogenous but display unique characteristics, backgrounds, motivations, and goals that demand a heightened sensitivity by all stakeholders.

Beyond the singular results related to parenting, the broader success of the MOVE program is heartening given the dearth of intervention research focused on these system-involved survivors. This investigation adds evidence for the acceptability and feasibility of the underlying intervention’s approach that pairs community-based agencies with social cognitive theory–based components focusing on behaviors, expectations, and self-efficacy. The positive research participation and retention rates provide evidence of the feasibility of the intervention with this vulnerable group of IPV survivors. Such participation suggests that system-involved IPV survivors are willing to be part of studies despite the additional scrutiny they and their families may face due to their CPS and/or court system involvement. These participation rates suggest that larger and more rigorous studies of interventions for this population could also be feasible.

Although the evidence here is promising, it is exploratory. Given the nascent development of MOVE, it is uncertain whether the results found herein are feasibly achievable by other programs or whether they may be attributable by a special confluence of factors. We agree with other IPV stakeholders that future inquiries should seek to answer such questions with (a) bigger samples, (b) comparison groups, and (c) using randomized designs (Choi & An, 2016; Rizo et al., 2011). It will also be important to replicate MOVE elsewhere to establish evidence for the intervention’s underlying approach. These tasks are particularly important to help improve the promising but still underdeveloped response strategies of professionals working with IPV victims (Choi & An, 2016).

One additional gap points the way forward for future research. Namely, why might some covariates be statistically significant but not others? Do system-involved IPV survivors with high educational attainment have unique parenting practices, for example? The statistically significant finding for African American mothers whereby participants’ race was associated with negative parenting practices demands further attention. The reasons for this phenomenon could vary. It may be that the MOVE program itself contained some systematic bias toward these mothers or that the parenting measures do not have measurement invariance across race/ethnicity. Research with larger samples of more diverse women is clearly necessary in this area. In the meantime, MOVE and other similar programs should strive to be attentive to the characteristics and needs of all women included in such interventions with a particular focus on how program contents, theories, personnel, procedures, and other factors may not attend to the needs and lived experiences of historically marginalized women.

Conclusion

The overarching goal of this pilot study was to advance existing research by examining key outcomes among a group of understudied female IPV survivors who were mothers and system involved and mandated to services following action by the court or CPS. It was hoped that participation in the program would be associated with meaningful improvements in survivors’ lives, with a particular emphasis on their positive parenting practices. Although preliminary and formative, the study’s encouraging pilot findings demonstrate strong initial promise for the intervention’s approach. These results will offer a foundation upon which other researchers and practitioners can continue to enhance and ensure beneficial practices for this vulnerable group of IPV survivors and their children.

Footnotes

Acknowledgements

We acknowledge the staff of InterAct and SAFEchild for their development of the MOVE program and their collaboration with this research. We also acknowledge Natalie Johns Montijo and Melissa Goodbourn for their help with this research.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding for this research came from The Duke Endowment (grant #1661-SP).

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