Experiences of identification and initial responses to children exposed to domestic violence: qualitative systematic review and thematic synthesis

Aim: to inform development of Canadian guidelines for health and social care professionals on children’s exposure to domestic violence and abuse (CE-DVA).
Objectives: to synthesise qualitative evidence on child, parent and professional views on the acceptability of identifying and responding to CE-DVA.
Methods: We re-screened papers identified in the previous review on CE-DVA (Howarth et al, 2017) and re-ran searches for new studies. Inclusion criteria: qualitative studies with children, non-abusing parents and health/ social care professionals which described their experiences of identification and initial response to CE-DVA. Findings from the studies were analysed using thematic synthesis.
Results: Searches identified 2,038 papers, 15 of which met inclusion criteria. The papers reported on 11 studies which involved 42 children, 220 mothers and 251 health and social care professionals. Children and mothers perceived health professionals as dealing with physical health and shared fears of stigma and negative consequences preventing them from disclosing DVA and engaging with services. However, they considered it acceptable if health professionals ask about safety at home when exploring causes of their symptoms. Children and mothers considered such questions to be acceptable if there was a good relationship with the professional. Children thought that adolescence is an acceptable age to see a doctor alone. Mothers considered it to be acceptable to ask children about DVA from the age of five. Professionals’ awareness of the impact of DVA on children, communication skills and the nature of the relationship with the mother influenced their acceptability of identification of CE-DVA. Major barriers for health professionals were: lack of time, competing priorities, uncertainty in cases of less severe DVA and emotional DVA, and poor interagency work. Social workers were perceived as threatening and punitive. Mothers and social workers had different understandings of risk assessment and safety planning. Practitioners wanted more training, brief and up-to-date resources with referral pathways, and better interagency collaboration.