The Effect of a Combined Parenting and Partner Violence Intervention on Multidimensional Outcomes of Family Violence

Globally one billion children under the age of 18 experience child abuse (physical, sexual, emotional) (Hillis et al. 2016). Child maltreatment not only violates the United Nations (UN) Convention on the Rights of the Child, but also is it recognized as a key public health problem. It has devastating consequences on both child well-being and the economy as a whole (Hillis et al., 2016; Mikton et al., 2014; WHO, 2014). The highest rates of child maltreatment (CM) were reported in low-and middle-income countries (LMICs). There is strong evidence from highquality systematic reviews that parenting programmes can reduce abusive punishment (Barlow, Simkiss & Stewart-Brown, 2006; Chen & Chan, 2016). Nevertheless, a systematic review found that most research on CM prevention comes from high-income countries (Mikton, & Butchart, 2009). First attempts to address the effectiveness of parenting programmes in LMICs come from African countries (Lachman et al., 2017; Mejia, Calam & Sanders, 2015; Puffer et al. 2015) with promising preliminary results. However, research is still l acking in low- and middle-income countries in other regions, such as Eastern Europe. Moreover, systematic reviews and one metaanalysis revealed only small to moderate effect sizes in the effectiveness of the examined parenting programmes (Euser et al. 2015; Knerr, Gardner & Cluver, 2013; Mikton & Butchart 2009).
Violence against children and against women are strongly related. First, intimate partner violence (IPV) and child maltreatment (CM) often co-occur in the same household (Casanueva, Martin & Runyan, 2009; Chan, 2011; Finkelhor, Ormrod & Turner, 2007; Hamby et al. 2010; Knickerbocker et al., 2007; Osofsky, 2003). Reviews of the rates of overlap of CM and IPV range from 30% to 60% (Appel & Holden, 1998; Edleson, 1999). Not only are the prevalence rates of child maltreatment high especially for LMICs, data from UN agencies suggests that 30% of women globally experience IPV at some point in their lives (Devries et al., 2013) and more than 25% in the WHO's European Region. Second, IPV is identified as a high-risk factor for child abuse (Milucci, 2015). The UN's Secretary-General's Study on Violence against Children indicates that women who experience IPV report child abuse by their partner more often than women without IPV victimisation with an increased likelihood of up to seven times (Covell, 2005). Findings from the UN Multi-country Study on Men and Violence [...], identified a strong relationship between IPV perpetration and harsh parenting by men (Fulu et al. 2017). Third, IPV 3 is recognized as a fundamental violation of human rights, not only harming the women enormously (Stöckl et al., 2013; Coker, 2007) but also damaging the well-being of exposed children (Fulu et al., 2013; Bourassa, 2007). Fourth, the combined effects of both IPV and CM are dually harmful. Children that experience both types of family violence are at higher risk of behavioural (Park, Smith & Ireland, 2012) and emotional problems (Wolfe et al., 2003; Herrenkohl et al., 2008), and multiple health outcomes (Hughes et al., 2017) than children experiencing only one type. Hence, interventions that consider intersectional forms of violence within the family in LMICs are needed. A new stream in research combines intervention models with a more comprehensive examination of violence against children. Some examples include, parenting interventions with cash transfer, farming skills training, and financial literacy in addressing the complex system of child maltreatment (Lachman et al. in preparation). Rutter et al. (2017) called for a wider set of approaches and a focus on the complexity of public health challenges in order to increase the effectiveness of interventions. The authors argue that single interventions with a small effect can drive large changes when applied in conjunction with other interacting factors within the system.