Project title:

IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): A scoping study and evidence synthesis

Type of research:

Mixed Methods evidence synthesis

Background & rationale:

Domestic violence and abuse () is threatening behaviour, violence or abuse between adults who are relatives, partners or ex-partners. Exposure to DVA during childhood and adolescence increases the risk of negative behavioural and health outcomes across the lifespan. There is a moderate to strong association between children’s exposure to DVA and internalising symptoms (e.g. anxiety, depression), externalising behaviours (e.g. aggression) and trauma symptoms. There are also links between children’s exposure to violence and disrupted social development, poor academic attainment, engagement in risky health behaviours and other physical health consequences. Exposure to DVA in childhood is associated with negative outcomes in adulthood, such as mental health problems, conduct disorder and criminal behaviour, as well as DVA victimisation and perpetration. Despite strong evidence that exposure to DVA is damaging to children in the short and long term, there is a paucity of evidence about clinically effective and cost-effective interventions that aim to prevent or limit the impairment that DVA may cause to children’s health and well-being.


This project was a collaboration between NIHR CLAHRC East of England and CLAHRC West and the Universities of Bristol, Central Lancashire and MacMaster in Canada.

Research objectives:

The aim of the evidence synthesis was to formulate recommendations for further research in the UK and internationally, that looks to evaluate interventions to improve outcomes for children exposed to .

The study team answered seven research questions:

  1. What is the nature of the evidence base evaluating targeted interventions to improve outcomes for children exposed to ?
  2. What is the nature of existing interventions to improve outcomes for children exposed to ?
  3. What is the evidence that existing interventions are clinically effective?
  4. What is the evidence that existing interventions are cost-effective?
  5. How are outcomes defined and measured in evaluations of existing interventions?
  6. What is the evidence that existing interventions are acceptable to stakeholders and feasible to deliver?
  7. What is the nature of the UK evidence base and service delivery landscape?


(1) A systematic review of controlled trials of interventions; (2) a systematic review of qualitative studies of participant and professional experience of interventions; (3) a network meta-analysis () of controlled trials and cost-effectiveness analysis; (4) an overview of current UK provision of interventions; and (5) consultations with young people, parents, service providers and commissioners.

Key findings and outputs:

We concluded that more experimental studies should be conducted in the UK to better understand which programmes work and which do not; that effectiveness should be measured against outcomes that are relevant and important to children, parents, service providers and policy-makers, rather than to researchers only; and that studies should examine whether or not different types of programmes are more or less effective and acceptable for different groups of people. We also identified three types of programme that we recommend should be prioritised for further evaluation in the UK: Parallel group based psychoeducation delivered to children and non-abusing mothers; parent training in combination with advocacy (practical support) for non-abusing parents; whole family approaches (those including children, non-abusive parent and abusive party).

Research recommendations (in priority order)

  1. Well-designed, conducted and reported UK-based RCTs with cost-effectiveness analyses and nested qualitative studies are needed to evaluate the clinical effectiveness, cost-effectiveness and acceptability of targeted interventions for children exposed to .
  2. Development of a consensus in the field about a core outcome data set.
  3. Exploration of the acceptability and effectiveness of interventions for specific groups of children and young people, differentiated by ethnicity, age, trauma exposure and clinical profile.
  4. Investigation of the context in which interventions are delivered, including organisational setting and the broader community context, as well as the influence of contextual factors on intervention fidelity and effectiveness.
  5. Evaluation of qualities, qualifications and disciplines of personnel delivering interventions.
  6. Prioritisation of psychoeducational interventions and parent skills training delivered in combination with advocacy in the next phase of trials.
  7. Exploratory trials of interventions that engage the abusive and non-abusive parent.


  • Howarth E, Moore THM, Welton NJ, et al. IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis. Southampton (UK): NIHR Journals Library; 2016 Dec. (Public Health Research, No. 4.10.) doi: 10.3310/phr04100.  Available from: 
  • Howarth, E., Moore, T. H. M., Shaw, A. R. G., Welton, N. J., Feder, G. S., Hester, M., … Stanley, N. (2015). The Effectiveness of Targeted Interventions for Children Exposed to Domestic Violence: Measuring Success in Ways that Matter to Children, Parents and Professionals. Child Abuse Review, 24, 297–310.
  • BITE Jan 2018: IMPROVE

Linked research and news 

For more information about the study, please contact Emma Howarth, Senior Research Associate:


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