Families with multiple needs: examining ways to prevent and address co-occurring parental domestic violence and abuse, mental ill-health, and substance misuse

Abstract

Parental domestic violence and abuse (DVA), mental ill-health (MH), and substance misuse (SU) are three adverse childhood experiences (ACEs) that are prevalent, (potentially) interrelated, and detrimental to parents and children. This thesis explores how we can better prevent and address co-occurring parental DVA, MH, and SU.

This thesis comprises: 1) a secondary data analysis utilising the Millennium Cohort Study to explore how parental DVA, MH, and SU co-occur during early childhood and how this impacts child MH trajectories; 2) a systematic review of family focused interventions that aim to address parental DVA, MH, and SU in combination; and 3) a qualitative study involving interviews with service users and focus groups with service providers and senior leadership/commissioners to develop an understanding of stakeholders’ experiences of current service provision for parental DVA, MH, and SU.

The secondary data analysis found parental DVA, MH, and SU co-occur during early childhood and that this can negatively impact children at age three. Families experiencing these co-occurring adversities were more likely to be experiencing socio-economic disadvantage. The systematic review identified no family focused interventions that had combined positive impacts on parental DVA, MH, and SU. Interventions mostly targeted mothers, those from low-socioeconomic backgrounds, and used an identification and referral approach to addressing multiple needs. The qualitative study highlighted the importance of early, relational support that addressed wider determinants. However, joined-up provision was challenged by an overwhelmed workforce and siloed services.

Overall findings highlight a lack of evidence on what works to prevent and address parental DVA, MH, and SU in combination. Working at the intersection of these ACEs is likely to require early, ‘think family’ support that addresses wider determinants, as well as more fundamental systems change. Future work should re-frame parental DVA, MH, and SU as a syndemic and co-develop approaches to better support families.