‘Domestic violence in particular is something we should be treating in a more integrated way'
Domestic violence image: Anne Holleman
As part of the SaFe Home research project, several care organisations in Leiden work together to treat domestic violence, with particular attention to psychological support. Health psychologist and researcher Marie-Louise Kullberg led the project and explains what they have learned.
When addressing domestic violence, care providers with different areas of expertise should ideally work together from a systemic perspective, involving the entire family in the treatment process. But what does that look like in practice? And what obstacles do professionals and families encounter? These were the questions investigated by Marie-Louise Kullberg and her colleagues in SaFe Home, a research project in which several youth care and mental health organisations in Leiden jointly draw up and implement a treatment plan. They were inspired by Switch, a similar initiative in Amsterdam that had proved effective. ‘In Amsterdam, Youth Protection played a central role. In Leiden, we worked with a larger number of different organisations, which made things more challenging in practical terms.’
SaFe Home
When domestic violence is identified within a family, support is currently often provided on an individual basis, particularly to the children. ‘In most cases, this is not yet a systemic approach or psychological treatment,’ says Kullberg. ‘It tends to focus more on practical support, for example with parenting, with the aim of getting the basics back on track. A lot of different professionals may be involved: community-based youth support, a mental health service for the child and support from the local neighbourhood team.’ SaFe Home takes a different approach by providing integrated support for the entire family, looking more closely at both the causes and consequences of the violence and offering psychological treatment where necessary.
Family plan
Since 2023, twelve families have started treatment through SaFe Home, following referrals from organisations including the Leiden women’s shelter Rosa Manus, Youth Protection and Veilig Thuis, the Dutch domestic violence and child abuse advice and reporting centre. For as short a period as possible, but for as long as necessary, they received support from different organisations on the basis of a jointly developed family plan. This support could range from individual therapy for parents and children, for example focusing on emotional regulation or trauma, to couples therapy or parenting support.
'Practitioners really needed to be able to deal with a very wide range of issues'
A broad range of expertise
Throughout the programme, Kullberg and her colleagues used questionnaires and interviews to investigate how both families and practitioners experienced the treatment process and what obstacles they encountered. ‘Beforehand, we expected people to present with a lot of trauma-related symptoms, but the range of difficulties was much broader: depression, anxiety, autism, behavioural problems and substance use. Practitioners really needed to be able to deal with a very wide range of issues.’ The key question at the start of each programme was therefore: where do you begin? ‘Often, it was important for parents to receive help with their own mental health problems first, so that they had the mental capacity to support their child.’
Inspiring
Different organisations worked together in teams and met regularly, sometimes with the families present and sometimes without them. The youth team often took the lead in coordinating care. ‘The practitioners found it inspiring to learn from different disciplines. Personally, I learned from colleagues working in forensic care to use the term “people who use violence” rather than “offenders”.’
Different terminology
Even so, the teams sometimes had to work to develop a shared vocabulary, and misunderstandings occasionally arose. ‘For example, there were different interpretations of what we mean by “family-focused treatment”. Does it mean taking the children into account during treatment, or does it mean actively working with all family members and, for example, providing family therapy?’ The term ‘coordination’ also meant different things to different practitioners. ‘It can mean determining what happens in a treatment programme from a clinical perspective, or it can mean coordinating the various services at a more overarching level.’ In her research, Kullberg identifies the use of a shared language as one of the conditions for successfully continuing SaFe Home. ‘What helped was that the team received training during the project based on a shared approach: attachment-based family therapy. That gave us a common perspective and a common language.’
Obstacles when getting started
Kullberg found that other challenges were mainly organisational. ‘In mental health services, there is often a long period between referral, assessment and the start of treatment. But in cases of domestic violence, problems are often acute; you want to strike while the iron is hot.’ In one family, for example, tensions escalated around the Christmas holiday period, but LUBEC was closed between Christmas and New Year. ‘It would have been better if support had started sooner and if the family had been able to obtain a referral more quickly.’ There were also many steps involved in getting a programme up and running, including referrals and completing forms. ‘Sometimes we would then discover that what we were offering was not suitable after all, and that, for example, addiction treatment was needed first, even though the family had already been waiting for some time.’ ‘I would like us to organise care in such a way that parents no longer have to approach several different services separately.’
'I would like us to organise domestic violence services in such a way that families no longer have to approach several different services separately'
Positive experiences
Families are still receiving support through SaFe Home, although data collection for Kullberg’s research has now been completed. De Waag is working with Leiden City Council to continue the initiative, as both families and practitioners have been predominantly positive about their experiences. ‘The violence has not stopped in every family, but every family has made progress.’
Tackling violence at family level
Kullberg therefore argues that an integrated approach, including psychological treatment, should become standard practice in cases of domestic violence.‘At a local level, I hope SaFe Home can be developed further and that more families in the region can receive support,’ she says. ‘More broadly, I would like us to organise domestic violence services in such a way that we are better able to work both with families and around them, so that they no longer have to approach several different services separately. That would allow us to focus properly on the substance of the problems and address the consequences of violence at family level.’
SaFe Home is funded through the ZonMw programme ‘What Works for Young People’ and was established in collaboration with Rosa Manus, De Waag, LUBEC Adult Care, LUBEC Child & Youth and Leiden City Council. The principal investigator was Professor Maartje Schoorl.