Rewind and Fast Forward: Understanding, improving and accelerating recovery in youth after family violence

Family violence is a worldwide problem, experienced by one in six people in childhood. As a consequence of family violence, children and parents may experience psychological problems, which may place considerable strain on parenting and the parent–child relationship. This dissertation aimed to understand, improve, and accelerate youth’s recovery after family violence. There is a gap in effective interventions for youth, as youth exposed to family violence frequently drop out of existing treatment programs and incidents of family violence often persist, while rapid recovery is crucial to limit the effects on their development as a person. To achieve the objectives of this dissertation, three central research questions were formulated: a) Which mechanisms contribute to youth’s recovery after family violence?; b) Which systemic elements are needed in trauma treatment for youth exposed to family violence?; c) How can treatment be optimized for families exposed to family violence? The first study in this dissertation is a longitudinal study that tested whether the mechanisms in Emotional Security Theory, that describes the pathways of family violence to youth psychosocial outcomes, could also serve as underlying mechanisms in youth recovery after family violence. Findings emphasize the importance of family safety in recovery of youth exposed to family violence. It revealed that reductions of PTS in youth were preceded by decreases in child-reported family violence and that parental stress played a role in decreasing parent-reported family violence. In contrast to theory and previous studies, parental stressors and emotional security were not mechanisms in the relationship between family violence and youth PTS. To address the effects of family violence at the family level and optimize treatment effects, the second study tested the effectiveness of a family-based intensive trauma treatment in a randomized controlled trial. Although it remains unclear whether family-based intensive trauma treatment improves treatment outcomes, it appeared to be promising in rapid reduction of PTS symptoms and optimizing treatment adherence. The third study, a qualitative study, showed that both the family-based component and the intensive format were valued by youth themselves and improvements were reported, even in youth exposed to ongoing family conflicts. Better screening on family safety and a trauma-informed health care system may improve treatment possibilities for youth with PTS symptoms after family violence.