Promoting resilience and wellbeing in children exposed to intimate partner violence: A qualitative study with mothers

Promoting resilience and wellbeing in children exposed to intimate partner violence: A qualitative study with mothers

Child Abuse & Neglect 95 (2019) 104039 Contents lists available at ScienceDirect Child Abuse & Neglect journal homepage: www.elsevier.com/locate/chi...

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Child Abuse & Neglect 95 (2019) 104039

Contents lists available at ScienceDirect

Child Abuse & Neglect journal homepage: www.elsevier.com/locate/chiabuneg

Promoting resilience and wellbeing in children exposed to intimate partner violence: A qualitative study with mothers

T



Alison Fogartya,b, , Hannah Woolhouseb, Rebecca Giallob,c, Catherine Wooda, Jordy Kaufmana, Stephanie Brownb,c a

Swinburne University of Technology, Hawthorn, Victoria, Australia Murdoch Children’s Research Institute, Parkville, Victoria, Australia c Departments of Paediatrics, The University of Melbourne, Victoria, Australia b

A R T IC LE I N F O

ABS TRA CT

Keywords: Intimate partner violence Parenting Child Resilience Qualitative

Background: Children exposed to intimate partner violence (IPV) are at increased risk of disruptions to their health and development. Few studies have explored mothers’ perceptions of what helps their children cope throughout this experience. Objective: The aim of the study was to explore mothers’ perceptions of their children’s resilience and coping following IPV exposure, and the strategies they have used to support their children and promote resilience. Methods: In depth semi-structured interviews were conducted with nine women from the Maternal Health Study (MHS), a prospective study of women during pregnancy and following the birth of their first child. All women involved in the qualitative interviews reported experiencing IPV during their involvement in the MHS. Transcribed interviews were analysed using interpretative phenomenological analysis which has a focus on how individuals make meaning of their experience. Results: Women discussed parenting strategies such as role modelling, stable and consistent parenting, and talking with their children about healthy relationships to promote their children’s resilience. Mothers also spoke about the ways they tried to reduce their child’s direct exposure to IPV, as well as reflecting on the difficulty of attending to their child emotionally when they were experiencing distress. Conclusions: This study highlights that there are many strategies used by mothers who experience IPV to promote resilience and wellbeing in their children. Understanding what mothers see as useful for their children is essential in providing appropriate services to families following experiences of family violence.

1. Introduction Approximately one in four children are exposed to intimate partner violence (IPV) during their childhood (Finkelhor, Turner, Shattuck, & Hamby, 2015). Exposure to IPV can be defined as living in a home where IPV is present, with research demonstrating similar detrimental impacts on children regardless of whether IPV is directly witnessed or not (Øverlien, 2010, Kitzmann, Gaylord, Holt, & Kenny, 2003). Children exposed to IPV are at an increased risk of negative health consequences such as emotional-



Corresponding author at: Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, Victoria, 3122, Australia. E-mail address: [email protected] (A. Fogarty).

https://doi.org/10.1016/j.chiabu.2019.104039 Received 28 October 2018; Received in revised form 21 February 2019; Accepted 4 June 2019 0145-2134/ © 2019 Elsevier Ltd. All rights reserved.

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behavioural problems, asthma, and cognitive and language delays (Bogat, DeJonghe, Levendosky, Davidson, & von Eye, 2006; Evans, Davies, & DiLillo, 2008; Holt, Buckley, & Whelan, 2008; Howell, Barnes, Miller, & Graham-Bermann, 2016). Despite these risks, there is a growing body of research documenting healthy development and pathways of resilient outcomes for children exposed to IPV (Graham-Bermann, Gruber, Howell, & Girz, 2009; Howell, 2011; Kitzmann et al., 2003; Martinez-Torteya, Anne Bogat, Von Eye, & Levendosky, 2009). 1.1. Resilience in children exposed to IPV Understanding what promotes the health, wellbeing and resilience of children exposed to IPV has been of increasing interest (Graham-Bermann et al., 2009; Howell, Graham-Bermann, Czyz, & Lilly, 2010; Martinez‐Torteya, Anne Bogat, Von Eye, & Levendosky, 2009). Key protective factors identified include maternal mental health, parenting style and responsive and sensitive mother-child relationships (Graham-Bermann et al., 2009; Howell et al., 2010; Martinez‐Torteya et al., 2009). Despite the importance of the mother-child relationship in promoting children’s health few studies have explored mothers’ perceptions of how they have supported their children’s health and development. The voices of mothers who have this lived experience are essential in designing appropriate and effective support services for families experiencing IPV. Defined as the maintenance of successful functioning despite exposure to a significant adversity (Luthar, Cicchetti, & Becker, 2000), resilient outcomes are dependent on interactions between an individual and his/her environment (Masten & Obradović, 2006; Wright, Masten, & Narayan, 2013). Factors which are protective for children exposed to a particular adversity have a strong potential to inform interventions aimed at reducing the onset of psychopathology in those at risk (Masten, 2011, Southwick, Bonanno, Masten, Panter-Brick, & Yehuda, 2014). Recent research seeking to identify protective factors for children exposed to IPV has had a strong focus on factors within the home environment (Kitzmann et al., 2003; Martinez‐Torteya et al., 2009). Maternal mental health has been at the centre of this research with several studies finding maternal mental health to be a significant predictor of outcomes in children exposed to IPV (Graham-Bermann et al., 2009; Howell et al., 2010; Martinez‐Torteya et al., 2009; Owen, Thompson, Shaffer, Jackson, & Kaslow, 2009). It has been proposed that mothers with good mental health are better equipped to model optimal emotion regulation strategies for their children (Howell et al., 2010; Martinez‐Torteya et al., 2009). Caregiver interactions and attachment are essential in the development of children’s emotion regulation. Maternal depression can disrupt these processes (Goodman & Gotlib, 1999), making it harder for mothers to facilitate this skill development. Maternal emotion coaching and attunement to children’s emotional experiences are also associated with positive outcomes for children exposed to IPV. Emotion coaching is a way of communicating with children that can facilitate the development of social emotional development (Gottman, Katz, & Hooven, 1996). In a sample of 30 mothers recruited from domestic violence services, attunement to children’s experience of sadness and anger was associated with resilience in behavioural outcomes (Johnson & Lieberman, 2007). A similar study of 95 mothers found that maternal awareness of their child’s negative emotions moderated the relationship between maternal mental health symptoms and children’s externalising and internalising problems (Cohodes, Chen, & Lieberman, 2017). Specifically, maternal emotion coaching of their children’s negative emotions moderated the relationship between maternal mental health symptoms and children’s internalising difficulties (Cohodes et al., 2017). These findings provide some evidence that mothers’ awareness of their children’s emotional experience and their ability to coach their children through emotions may provide a buffer against the negative impacts of exposure to IPV. Parenting styles and mothers’ responsiveness and sensitivity to their child are significant determinants of secure attachment relationships (Bakermans-Kranenburg, Van Ijzendoorn, & Juffer, 2003; Goodman & Gotlib, 1999). Given this, several studies have investigated parenting as a protective factor in children exposed to IPV. For instance, effective parenting (characterised by warmth, control, child centeredness and consistency) has been associated with positive emotional-behavioural outcomes in children within a sample of 219 mother-child dyads (Graham-Bermann et al., 2009). Similar results were found by Howell et al. (2010) for the role of parenting practices, defined by parenting involvement, positive parenting, supervision and discipline practices. Other studies have found no associations between parenting and positive child outcomes. For instance, in a community sample of 190 mothers, positive parenting (characterised by consistent discipline, nurturing parenting and less harsh parenting) was not associated with positive outcomes for children exposed to IPV (Martinez‐Torteya et al., 2009). Taken together, these studies suggest that although maternal mental health and emotional attunement are protective for children exposed to IPV, the specific parenting practices which are most beneficial for children exposed to IPV remain less clear. There is a need for future research to determine what mothers can do to promote wellbeing in their children following exposure to IPV. 1.2. Qualitative research with mothers who have experience IPV Despite research into the contribution of mother-child relationships on resilience among children exposed to IPV, few studies have explored the voices of mothers and their perception of what promotes positive outcomes for children. A qualitative study of 26 mothers who had experienced IPV emphasised how violence towards women adds unique challenges to mothering including the increased responsibility placed on them to look after their child (Lapierre, 2009). Lapierre (2009) highlighted that the current literature on parenting does not give due acknowledgement to how IPV complicates women’s role as a mother. Research highlighting deficits in parenting within the presence of IPV can contribute to a blaming culture whereby mothers are labelled ‘inadequate’. A qualitative study of 17 lower-income mothers involved in child protection services identified strategies they use to promote their children’s physical and mental health (Haight, Shim, Linn, & Swinford, 2007). These included (a) clear and appropriate communication about the current situation, (b) providing emotional support and reassurance, (c) offering education around relationships, 2

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and (d) separating the spousal and parental role of their partner to allow their child to develop their own relationship with their father (Haight et al., 2007). The findings from this study also highlighted the complex nature of trying to protect children’s psychological wellbeing. Specifically, that an individual’s cultural background and life experiences may alter perceptions of what are effective strategies or the need to implement such strategies (Haight et al., 2007). An understanding of the strategies mothers use to promote the wellbeing of their children will inform future policy and interventions for mothers and their children exposed to IPV. Approaches which build on the strengths and strategies mothers are actively practising are essential in ensuring mothers feel empowered when seeking help. 1.3. Study aims The few qualitative studies on children exposed to IPV have not examined parenting strategies within a community sample of mothers who have experienced IPV, nor have they asked mothers more broadly about what has helped their children stay resilient throughout their experiences. The current study aimed to use qualitative interviews to explore mothers’ perceptions of how their children have coped with IPV exposure, and the strategies they have used to support their children and promote a sense of resilience. This study builds on previous literature by exploring mothers’ perceptions of their child’s resilience within a community sample of women with experiences of IPV. We believe this study provides valuable insight into mothers understanding of resilience processes in their children. This contribution to the field has important implications for working with mothers and children exposed to IPV as well as informing future quantitative research in this area. 2. Method 2.1. Study design 2.1.1. The maternal health study The MHS is a prospective pregnancy cohort study investigating the health and wellbeing of mothers during pregnancy and following the birth of their first child. Approximately 6000 women who were registered to give birth at six metropolitan hospitals across Melbourne between April 2003 and December 2005, were invited to take part in the study. Women were eligible to participate if they were: (a) 18 years or older; (b) nulliparous; (c) had an estimated gestation of up to 24 weeks at the time of enrolment, and (d) were sufficiently proficient in English to complete written questionnaires and participate in telephone interviews. Data were collected during pregnancy, at 3, 6, 9, 12 and 18 months postpartum and when their first child was 4 and 10 years of age. The current study draws on data collected at 12 months, 4 years and 10 years postpartum to describe the qualitative sub-study sample’s demographic characteristics, IPV exposure across the study period, and maternal mental health and children’s emotional-behavioural functioning in the most recent 10 year follow-up. Ethics approval for the study was sought from the participating hospitals, La Trobe University, and the Royal Children’s Hospital, Melbourne and full details of the study design, sampling and methods can found in the published study protocol (Brown, Lumley, McDonald, & Krastev, 2006). 2.1.2. Qualitative sub-study The current study was designed as a nested qualitative sub-study, occuring approximately 12–18 months after the 10 year survey follow-up. Ethical approval for the nested qualitative sub-study was provided by the Royal Children’s Hospital Human Research Ethics Committee and Swinburne University of Technology’s Human Research Ethics Committee. The study procedures were informed by the guideline ‘Putting Women First: Ethical and Safety recommendations for research on domestic violence against women’ (World Health Organization, 2001), approved by the WHO Steering Committee for the Multi-Country Study on Women’s Health and Domestic Violence against Women. 2.1.3. Qualitative study participant recruitment All MHS participants registered as active at the 10 year follow-up were invited by mail to participate in face-to-face interviews about their experiences of difficulties in relationships since having their first child. To ensure the safety of all MHS participants, the words ‘violence’ or ‘abuse’ were not included in this invitation. Previous findings from the MHS indicated that 28.9% of women had experienced some form of IPV within the first four years of having their first child (Gartland et al., 2014). Invitations were sent out between August and November 2016 to 1151 women. The recruitment letter directed interested participants to contact a MHS researcher by phone to discuss their eligibility. During this phone call, a researcher explained to the participant that we were interested in speaking to women who had experience emotional, physical or sexual abuse by an intimate partner since the birth of their first child. A description of different kinds of abuse based on the Centre for Disease Control document ‘Intimate Partner Violence Surveillance: Uniform definitions and recommended data elements’ (Breiding, Basile, Smith, Black, & Mahendra, 2015) was offered. At this point, participants were asked if they would like to continue exploring eligibility or whether they would like to discontinue the conversation. Participants who agreed to proceed were then screened for eligibility using the following question: “Since you were pregnant with your first child, have you ever experienced physical or emotional abuse from someone who was your current partner or former partner?” If participants answered yes to this question they were deemed eligible to participate. Participants who consented to participate were invited to attend a semi-structured interview with a MHS interviewer at the Royal Children’s Hospital. From the 1151 invitation letters sent out, 74 women expressed interest and 14 were deemed eligible to participate. Of the eligible women, nine attended a face-to-face interview. 3

Age

41 42 42 45 48 48 49 53 54

Pseudonym

Anisha Priya Joanne Amanda Sarah Emma Lisa Chloe Lauren

Table 1 Sample Characteristics.

12 13 11 12 12 11 11 10 11

Age of first child Yes Yes No Yes Yes No No Yes Yes

Currently in relationship Yes Yes No Yes No No No Yes Yes

Current IPV relationship 3 1 1 1 2 1 2 1 1

Number of children Certificate/Diploma University Degree Certificate/Diploma Below year 12 Certificate/Diploma University Degree Certificate/Diploma Year 12 University Degree

Education level

Paid employment Paid employment Paid work Neither paid employment or study Neither paid employment or study Paid work Study Paid work Paid work

Employment status

India India New Zealand Australia Australia Australia Australia Australia Australia

Country of birth

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Table 2 Descriptive statistics for study variables. Measures

Range

M

n = 9, n (%)

Children’s emotional-behavioural functioning - Normal range Maternal depressive symptoms - Above cut-off (13) Children’s exposure to IPV - 12 months postpartum - 4 years postpartum - 10 years postpartum - At no time point

0–10

6

9 (100%)

0–26

8

2 (22%)

4 2 4 3

(44%) (22%) (44%) (33%)

Characteristics of the sample are presented in Table 1. The mean age of participants was 47 years, and the mean age of their first child at the time the qualitative interviews were conducted was 11 years. All women reported being in heterosexual relationships at the time of their experiences of IPV, and all women reported experiencing IPV by the father of their child/children. One women also reported IPV in a subsequent relationship. No women reported incidents of violence directed towards children. Table 2 displays descriptive statistics for children’s emotional-behavioural functioning, exposure to IPV, and maternal depressive symptoms collected as part of the MHS 10 year follow-up. IPV was reported by four of the women in the 12 months preceding 12 months postpartum, by two at 4 years postpartum, and by four at 10 years postpartum. Although three women did not report experiences of IPV on the CAS in the 12 months prior to the 12 month, 4 and 10 year follow-up surveys, at the time of assessing eligibility for the qualitative sub-study they confirmed experiences of IPV at some point since the birth of their first child. Two of the nine participants were experiencing clinically significant depressive symptoms at the time of completing the 10 year follow-up. All children were scored by their mother to be in the normal range for emotional-behavioural functioning. 2.1.4. Measures Children’s emotional-behavioural functioning was assessed in the 10 year follow-up survey using the parent report of the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997). The SDQ is a 25 item assessment children’s emotional-behavioural symptoms such as sadness, worry, behavioural and attentional difficulties and peer problems. Items are rated on a 3 point scale ranging from 0 = not true to 2 = certainly true. Scores are summed to form a total difficulties score, with higher scores indicating more emotionalbehavioural difficulties. The SDQ has Australian normed pre-defined cut-off which indicate scores falling within the ‘normal’ (0–13), ‘at risk’ (14–16) and ‘clinical’ (17–40) range (see www.sdqinfo.com). Maternal depressive symptoms were assessed in the 10 year follow-up survey using the 10 item self-report Edinburgh Postnatal Depressive Scale (EPDS) (Cox, Holden, & Sagovsky, 1987). The EPDS asks women to report the extent to which they have experienced past week (0= never, 1=not often, 2= sometimes, and 3= most of the time). The EPDS has been well validated in pregnant, post-natal and non-postnatal women, with a cut-off score of ≥ 13 recommended to identify probably clinical depression (Cox, Chapman, Murray, & Jones, 1996; Murray & Cox, 1990). Children’s Exposure to IPV was assessed at 12 months, 4 years and 10 years postpartum using mothers’ reports on the 18 item shortened Composite Abuse Scale (Hegarty, Bush, & Sheehan, 2005; Hegarty, Sheehan, & Schonfeld, 1999). The CAS asks women how frequently they experienced a range of behaviours constituting emotional or phsyical violence during the last 12 months (never, only once, several times, once per month, once per week, daily). Women are assessed as experiencing IPV if they score ≥ 3 for emotional abuse items, or ≥ 1 for physical items. The CAS was developed and validated within Australian populations (Hegarty et al., 2005). 2.1.5. Qualitative interviews Semi-structured face-to-face interviews, ranging between 60 and 120 min in length were conducted by a female MHS researcher with postgraduate training in psychology and counselling experience. Interviewers attended a one-day training workshop in risk assessment and safety planning. The interview schedule asked questions in the following areas: (a) experiences of abuse within relationships, (b) making decisions around staying or leaving relationships, (c) parenting, (d) how they and their children coped, and (e) help seeking. This study draws upon data pertaining to mothers’ perceptions of how their children have coped with their experiences of IPV. Although a schedule was used, the interviewers emphasised to participants that they were interested in their unique story and participants were encouraged to speak about areas pertinent to their experiences. 2.2. Data analysis Eight of the nine interviews were audio-recorded and transcribed verbatim with one participant declining the recording of her interview. In this case, written notes were taken during the interview and these notes used for data analysis. Interview transcripts were analysed using interpretative phenomenological analysis (IPA) (Smith, 2009). This approach was chosen due to its focus on the lived experience of a particular phenomenon and how individuals make meaning from their experience (Larkin, Watts, & Clifton, 2006). The analysis was conducted using qualitative software NVivo Version 11 (QSR International, 2015), and guided by the steps described by Smith and Osborn (2003). All transcriptions were double coded by the interviewers. The initial step involved a thorough 5

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Fig. 1. Key themes relating to mothers’ perceptions of resilience in their children exposed to IPV and strategies they have engaged in to promote positive outcomes.

read through of all transcripts to increase familiarity and to annotate initial thoughts and interpretations of the data. Following this, each transcript was coded, grouping commonalities into nodes. These nodes were reviewed and reorganized into higher-order nodes to determine broad over-arching themes of the data. IPA was conducted by two researchers. Results were compared with no major discrepancies identified between researchers. Researchers integrated minor differences into their respective coding framework. To further increase reflexivity, the researchers met with the Principal Investigator where a discussion around the themes and subthemes took place. Specifically, a discussion of the data and corresponding themes occurred to reflect on their accuracy and to gain a consensus on the best way to represent the data. This process also occurred with the broader MHS research team. 3. Results 3.1. Qualitative analysis The final themes and subthemes for the current analysis are displayed in Fig. 1. Mothers’ narratives around what was helpful for their children fell into the broad themes of: (1) parenting strategies, (2) reducing the impact of children’s exposure to IPV, (3) making choices around father involvement, (4) importance of interest hobbies and sport, and (5) mothers’ wellbeing. These will now be discussed in turn. 3.1.1. Parenting strategies When asked how they saw their children coping with experiences of IPV exposure, mothers spoke of actively engaging in behaviours to try to mitigate the risk to their children’s wellbeing. These strategies were themed into role modelling, stable and consistent parenting, and talking about healthy relationships. 3.1.2. Role modelling Mothers spoke of their efforts to be a strong positive role model for their child. For those who remained in IPV relationships, this was particularly evident with mothers describing standing up for themselves in arguments more as their child grew older. Role modelling having a career and independence was also important. Chloe and Anisha described how they use role modelling with their children. Caitlin knew what was going on. She really shouldn’t be exposed to that but it was like, she has seen that I am not putting up with his bullying. I haven’t used that word before his bullying. She’s got to see that I’m not going stand for that. (Chloe) I need to move forward, especially for my kid, they need to see that as a girl, she needs to see regardless of what anyone says to you, you say what you think in a respectful way and you need to move on. (Anisha) 3.1.3. Stable and consistent parenting Mothers spoke about the importance of creating stability and consistency within their children’s lives despite the instability often 6

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present due to IPV. Mothers described this as a challenge, but also a priority. Sarah described efforts to ensure her child had what he needed for school despite her ex-partners control over finances. In the last year he’s been to California, Paris, Germany, Spain, Thailand and Hawaii, but he’s $8000 behind in maintenance. I say to him, “What do you think I do with the money?” I’ve got tops that I’ve got from the Red Cross $2 shop. I don’t care, it’s $4, it does the job. I don’t need to have new things. I don’t need to go on a holiday. I’m trying to get things organised for the kids. Nathan is in High School next year, we’ve got to get books, we’ve got to get uniforms. (Sarah) Similarly, Emma described efforts to keep her son’s life as stable as possible through the difficult time of separating with her partner. I didn’t want to blow the mine open so to speak. I didn’t want to make it bad for the purposes of Jack having an enduring relationship with his father…. It did go through my mind “should I change the locks? What do I do? Should I just change the locks now? Should I just do that?” But in doing that I’m then making a grand statement that would make it harder for him to pick Jack up, take him home, take him to sport. The impact of that would have been real. I didn’t want to jump to that unnecessarily. (Emma) I needed to create stability for her for sure and I didn’t think it was fair. It was my mistake so I didn’t think it was fair you know. Her world had already been turned upside down. I didn’t think it was fair that she had to change her school or anything like that as well. That would have been awful. (Joanne) Lastly, mothers described that it was difficult to be consistently available to their children when experiencing instability and violence within their intimate relationship. Lauren described how despite the difficulty, this was something that she prioritised. We’ve tried doing different connections in the brain and doing exercises. Doing playful artistic and being hands on and we’ve done everything, always. We’d always have a full agenda during holidays and after school. So there would always be things going on and he was always interested in that. (Lauren) 3.1.4. Talking about healthy relationships Mothers described creating an open and honest dialogue about their children’s experiences of witnessing disrespectful or abusive behaviours. Mothers expressed a willingness to discuss what behaviour is, and is not acceptable within relationships with their children, and made conscious efforts to have these conversations. These comments were often closely tied to stories of mothers’ efforts to strengthen their relationship with their child and the importance of having the capacity to recognise and respond to their child’s emotional needs. For some mothers, the feeling that they did not have the capacity to support their children due to the impact that IPV on their mental health, was a trigger to leave their relationship. Others were able to provide this support and communicate with their children despite remaining in their relationship. I speak truth to him within his ability to understand and I try to be really balanced because I know what it’s like when your parents hate each and they are playing those games, it’s pretty awful. I just said to him “mate, that’s still not ok, it’s not ok, I suffered stuff as a kid too but I don’t act like that” and he agrees. (Emma) Daniel is at that age where he needs to be empowered as well. So we will be walking down the street and he’ll identify someone that he doesn’t feel comfortable with, so he’ll ask to move or do something. So it is about him working out who is safe and who isn’t safe, and then clearly what is acceptable and what is not. And I have had these discussions with him, and sort of pointing out “do you think that’s acceptable behaviour?” and he’ll say “no mummy”. And then he’ll say to me, “sometimes I don’t know why you don’t say something?, or why you do say something?” he said “just ignore him”. But I’m not complaining to him that that’s the way that it is He is just recognising there is things here. And so in effect I try to make it open for him so that he can understand what is right and what is wrong and that he doesn’t follow the same path. He is more my priority. (Lauren) Sarah described how her experiences of IPV impacted on her interactions with her children. I was grumpy. I was tired. It had an impact on them because I didn't have the time with them. I was just quick. Then they’d say something like, ‘mum, I want this’, and I’d say, ‘what do you want now’? It had an impact on them ‘cause they could see that I wasn’t happy. They do see that. Even at such a young age they can see that. (Sarah) 3.2. Reducing the impact of children’s exposure to IPV 3.2.1. Reducing direct witnessing of IPV Some mothers reported that their child/children were too young at the time of the IPV to be aware of what was going on, or that the IPV occurred when their children were in their rooms, asleep or at school and therefore were not aware of its occurrence. However, other mothers spoke about trying to hide the abuse from their children by delaying or de-escalating conflict. These mothers recalled being highly attuned to their partners’ emotional state to detect signs that he may be at risk of engaging in verbal or physical abuse. Chloe described how she would continually monitor the situation with her partner and use strategies to diffuse the situation when her child was in close proximity. Well you know, there is so much real and threatened violence that I had no idea what would happen to those threats….there were points in arguments over the years that I just stopped because it was too provocative. Like no I can’t argue against that anymore it is too provocative. 7

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I’d give in, or I would pretend to, I’d pretend to agree with him. Just to diffuse things. Go along with things, to diffuse it. Just damage control. For safety. (Chloe) Then you know, dragged by the hair. Not nice. Then Caitlin is in the house so I’m trying not to make any noise, and if I do, then it’s my fault. If I make noise “why did you do that? why do you do that?” (Chloe) 3.3. Making choices around father involvement Making decisions about the involvement of their child’s father in their lives was spoken about by all mothers. Mothers reflected the important role that fathers play in the lives of their children, and often put this above their own needs of safety. Mothers described this as being a significant and important decision, and one that they were continually re-evaluating. 3.3.1. Staying in relationships Of the nine mothers interviewed, five expressed strong views on the importance of staying in their relationships as they believed that this was best for their children. These mothers spoke about how important it was for their children to have their father in their life, and believed that the process of separating from their partner would be extremely detrimental to their children. For this reason they choose to remain in their relationships, prioritising their child’s need to have a father over the impact of that IPV was having on their lives. Lauren and Amanda describe their decision making process below: I’ve done what I can to keep Daniel’s dad close. Regardless of who he is. Because I’m not sure which is worse. Separating or staying together. For Daniel staying together is better. For me, leaving him years ago would have been better. (Lauren) I probably would have left him if he wasn’t there. I think a child needs his dad. That’s what I think. If he wasn’t there we probably would have split. (Amanda) 3.3.2. Ensuring continued contact with father post-separation Some mothers decided to separate from their partner as a result of IPV. However, these mothers did what they could to ensure their children had continued relationship and contact with their father post-separation. For Jack’s sake, I think it’s important. Greg still sees Jack, picks him up, takes him to training, that sort of thing. Jack won a football award in September. He came second in the league for best and fairest and you get the thing that you can invite two people and I knew that he wanted to invite his dad…. so I felt that we probably needed to go together for Jack’s sake. (Emma) 3.3.3. Providing children with the opportunity to have their own opinion of their father Some mothers discussed the importance of not speaking about their partner in an unfavourable light in front of their children. This was to preserve the relationship their child had with their father. Emma explained the importance of this for her: He is very close with me but for me it’s important that he develops his own attitude of his father based on his own experiences, not based on what I think or I feel so I try to keep it as balanced as possible. (Emma) 3.3.4. Dynamic nature of decision making When mothers spoke of how they made decisions around father involvement, it became evident that this was a dynamic process which they continued to reassess over time. Mothers spoke of continually reflecting on what they viewed as most important for their children. Specifically, mothers discussed weighing up the importance of their child being in close proximity to their father versus the potential negative impact that their partner’s behaviour was having on their child. Two of the mothers spoke of how their priorities shifted over time. Both mothers initially thought that it was important for their child’s wellbeing to stay in the relationship, or to ensure their child had regular contact with their father. However, over time their view changed, and they actively reduced or eliminated the father’s contact with their child. For one mother, she chose to do this after noticing a negative psychological impact on her daughter. For both mothers, this also occurred after their children voiced a desire not to be spending time with their father. I was always torn between, well she does need her dad but then when it started to have an effect on her emotionally it was like ‘nah, no, I don’t think so’. She doesn’t need him. (Joanne) I loathe break ups where children are forced to go from one parent to the next. I think that’s the most awful thing you can do to a kid. So, that was awful for me to contemplate that I’m going to join that tsunami wave. But, first and foremost I had to put myself at the top of the tree and go, I’m responsible for these two kids, and if I keep going the way it is I will just be hopeless, and then they’ll be fed with all of this poison as well. So, I don’t want that. (Lisa) 3.4. Importance of interests, hobbies and sport Mothers spoke about the important role that regular engagement in an interest, hobby, sport and school had on their child’s wellbeing. Mothers perceived that these experiences provided their child with enjoyment and the opportunity to enhance their sense of confidence and independence. For this reason, mothers sought to encourage their child to continue to engage in these activities. 8

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I think that he really loves sport and I think that that’s a really positive thing in his life that he achieves, he is not the best at everything but he does pretty well. So I think that that is something that he does that makes him feel good about himself. (Emma) She’s realised that she can succeed in things and be appreciated. She’s got interests that she really likes. Socially things are going pretty well. (Chloe) 3.5. Mothers' wellbeing Mothers described that feeling emotionally well was essential for being in the best position to fully meet the needs of their children. One aspect of this was to appear stable, contained, and under control in front of their children, so that they know that everything is ok. Despite recognising the importance of their own wellbeing, mothers rarely prioritised their own Wellbeing and often sacrificed their own needs to do what they believed would be best for their family. So, I had to do what I had to do to make sure that this was okay. Something had to be okay so this had to be okay, and the kids had to be okay. He had to be okay. And, just, kind of, put everything else that I was thinking or feeling off in the background. (Anisha) I’m a survivor. I’ve always coped, with lots, with a lot in my life so it was really hard to feel so out of control emotionally, and then have to try to be really positive for Jack to try to make sure that he was ok. The most important thing was that he wasn’t impacted, more than he need be. (Emma) 4. Discussion Giving voice to mothers with a lived experience of IPV, this study explored their perceptions of children’s resilience, and the strategies they have used to buffer the potential negative impacts on their children. This study is unique in its focus on mothers’ perceptions of their children’s resilience and in its inclusion of a community sample of mothers who have experienced IPV. When reflecting on what has helped children throughout their experiences of IPV, there were five main themes: (1) parenting, (2) making choices around father involvement, (3) reducing impact of exposure to IPV, (4) importance of interests, hobbies or sports, and (5) mothers’ own wellbeing. These themes will be discussed in turn with a particular focus on parenting and making choices around father involvement due their clinical implications. All children of the mothers who participated in interviews scored in the normal range for emotional-behavioural functioning at the 10 year survey follow-up, which was in the 12–18 months prior to the qualitative interviews. This suggests that the children were experiencing emotional-behavioural resilience despite their exposure to IPV. It might be that mothers with children who are doing well were more likely to take part in our interviews. Our sample reflected a range of presentations in relation to the timing of IPV exposure and mental health presentations. Two of the women interviewed were experiencing clinically significant symptoms of depression at the time of the 10 year follow-up and three women did not report experiences of IPV in the 12 months prior to the 1, 4, and 10 year follow-up surveys. Despite this, these women confirmed their experiences of IPV when assessed for eligibility for the qualitative interviews. Parenting strategies were a focus of the interviews with all mothers reporting using at least one or multiple strategies to promote their children’s wellbeing. Some of the strategies described differed from those mentioned in previous research (Cohodes et al., 2017; Graham-Bermann et al., 2009; Howell et al., 2010; Johnson & Lieberman, 2007). For example, discipline and supervision were not discussed by the mothers interviewed. Emotion coaching and warm and nurturing parenting was also not directly spoken of, however aspects of these practices may be evident within the strategies discussed. Although maintaining consistency in their parenting was a challenge, mothers saw this as a priority. These findings expand on Lapierre’s (2009) research, where mothers experienced a loss of control in their parenting due to their partner’s behaviour. In the current study, a number of mothers placed high importance on providing consistency and stability in their children’s life. Disruptions to consistency contributed to mothers’ feelings of inadequacies within their parenting and this was a source of distress. However, mothers spoke of conscious efforts and successes in creating stability in their child’s life. Interventions which acknowledge the challenges mothers face in creating stability, and helping them to manage this may be beneficial for families who have experienced IPV. Mothers discussed role modelling and talking about healthy relationships as a potential way to lessen the negative impact of IPV exposure on their children. Mothers acknowledged the risk of their children developing negative messages about intimate relationships through observing their relationship with their partner. Mothers spoke of attempts to correct this through positive role modelling and overt discussions of healthy relationships. For some mothers this meant verbally labelling emotionally abusive behaviours by their partner when they felt that it was safe to do so. For others, it was around role modelling independence and career progression. Breaking the cycle of abuse was key in mothers’ minds when engaging in role modelling. It is well established that those who are exposed to IPV in childhood are more likely to experience or perpetrate IPV later in life (Bensley, Van Eenwyk, & Simmons, 2003; Maker, Kemmelmeier, & Peterson, 1998; Temple, Shorey, Tortolero, Wolfe, & Stuart, 2013). However the extent which mothers role-modelling may mitigate this risk is worthy of further investigation. Choices around father involvement was a predominant theme throughout the interviews. Children were central to mothers’ discussions around leaving or staying in relationships. Mothers strongly believed that keeping their child’s father close was a priority for their child’s wellbeing. This finding builds on existing literature that prioritising the father-child relationship is often a barrier to leaving violent relationships (Rhodes, Cerulli, Dichter, Kothari, & Barg, 2010). However, this study demonstrates the dynamic nature 9

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of mothers’ decision making processes and that when the impact of IPV on their children was evident, they were more likely to make the decision to leave. Although mothers also reported other barriers to leaving such as concerns over physical or emotional safety and financial resources, ensuring that fathers remained involved continued to be a priority. For the majority of participants, their partner or ex-partner continued to have frequent contact with their children. This experience is reflective of findings of Salisbury, Henning, and Holdford (2009) that over 63% of fathers convicted of a family violence offence had weekly, ongoing contact with their child. Despite this, there are few evidence based interventions for fathers which address both IPV and parenting (Labarre, Bourassa, Holden, Turcotte, & Letourneau, 2016).There is a need for research into how such interventions can support fathers to stay involved and change their behaviour, whilst supporting women’s autonomy around decision making and child safety. Many mothers spoke of the importance of their child/children engaging in activities they enjoyed, in order to build self-confidence and belief in their own abilities. Resilience theory recognises that self-confidence and self-efficacy, along with experiences of success and achievement are important elements to developing positive cognitive coping strategies (Masten & Coatsworth, 1998; Rutter, 1985). Encouraging children to engage in hobbies and interests, might be particularly useful for children exposed to IPV to increase the self-efficacy and confidence that is important for promoting their resilience. Mothers described how difficulties in their mental health had impacted on their ability to be emotionally available to their children. This finding provides a qualitative perspective to prior quantitative findings around importance of maternal mental health in promoting resilience in children exposed to IPV (Howell et al., 2010; Martinez‐Torteya et al., 2009). Additionally, it supports the hypothesis that mothers who are experiencing higher levels of psychological wellbeing have more emotional resources to respond adaptively to their children’s emotional experience (Howell et al., 2010; Martinez‐Torteya et al., 2009). Despite this, mothers described prioritising their child’s immediate needs over their mental health (e.g. “put everything else in the background”), indicating a potential barrier in mothers’ help seeking. The majority of the mothers interviewed (78%) reported no or minimal depressive symptoms at the time of the most recent 10 year follow-up survey. It might be that good mental health enabled these mothers to effectively implement that strategies discussed. Psychological wellbeing needs to be viewed as an essential step in building capacity to being emotionally available and promote positive wellbeing for their children (Lieberman, 2007). 4.1. Study strengths This is the first known qualitative study to explore mothers’ experiences of IPV within a sample derived from a population based cohort study. Therefore these results contribute to a unique understanding the mothers’ experiences of IPV within a community sample. Often lacking from studies derived from domestic violence shelter populations, this study captured the experience of both physical and psychological violence within relationships. Lastly, the qualitative approach of this study provides a platform for mothers to tell their stories. It is vital that women’s voices inform service providers and researchers as to what is most beneficial for their families. 4.2. Limitations and directions for future research The current findings should be considered within the limitations of the study. First, mothers within our sample were relatively homogeneous in nature. None of the participants spoke of using domestic violence shelters in the past, nor reported violence directed towards their child. Moreover, mothers who chose to participate are likely to be individuals who have had the opportunity to process their experiences and have access to social, emotional or financial resources enabling participation. Therefore the results of this study are unlikely to represent the experience of mothers experiencing severe physical violence, high levels of social isolation or economic disadvantage. In addition, although mothers’ reported on their experiences of IPV at three 12-month periods at 12 months, 4 and 10 years postpartum, we did not capture their IPV experience between the study periods. This study implemented a complex recruitment process to protect the safety of all MHS participants, as well as to prioritise women’s own perspective of their experiences within relationships. It is possible that some women who expressed interested in participating but were deemed ineligible, did have experiences of violence within their relationships however were not viewing their circumstances in this light. This may have limited the size of our sample (n = 9) and impacted on the ability to meet saturation. There are many factors which might impact on the parenting strategies employed by mothers following experiences of IPV. For example, ethnicity, relationship status and number of children within the household may be particularly influential. It is recommended that future research explore how such factors interact with parenting within families where IPV has occurred. In addition, this study interviewed only mothers, and consequently was not able to obtain triangulation of findings. Future research should aim to include children and, where safe to do so, fathers to gain a more rigorous understanding on what assists children to maintain normal development when exposed to IPV. Lastly, the current study highlighted a number of strategies which mothers perceived as contributing to resilience in their children following IPV exposure. Due to the qualitative nature of this study, the effectiveness of these strategies were not assessed and could be a focus for future research. 4.3. Implications and conclusions The current study has important implications for clinical practice and future research. Our findings demonstrate that mothers experiencing IPV hold significant concern about the wellbeing of their children and that this is often prioritised over their own health. Additionally, our findings highlight that mothers’ decision making around father involvement and remaining or leaving IPV 10

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relationships is complex and dynamic, centring on the best interests of their children. Despite experiences of IPV, many mothers’ do value the involvement of their children’s fathers in their lives. There is a need for further research into policies and interventions which recognises these complexities and, where appropriate, support fathers who remain involved with their families following IPV. Multiple parenting strategies were identified by mothers as important in promoting their children’s wellbeing. Although further research is needed to determine the effectiveness of these strategies, this knowledge has the potential to inform interventions for mothers and children exposed to IPV. In addition, all mothers within the study reported engaging in strategies to promote resilient outcomes for their children within these situations. Working with mothers from a strengths-based approach, where these strategies are recognised and built upon may assist mothers to feel empowered and understood throughout their experiences. Lastly, despite mothers discussing the impact that their mental health was having on their interactions with their children, many mothers found it difficult to prioritise their own health and wellbeing. Encouraging mothers to view their own mental health as an essential component in addressing their children needs is critical in promoting positive outcomes for children. Funding This work was supported by grants #199222, #433006 and #491205 from The National Health and Medical Research Council (NHMRC), a VicHealth Research Fellowship (SB), an ARC Future Fellowship (SB), an NHMRC Career Development Fellowship (SB), Australian Government Research Training Program Scholarship (AF), a grant from the Medical Research and Technology in Victoria Fund (ANZ Trustees) and Murdoch Children’s Research Institute research is supported by the Victorian Government’s Operational Infrastructure Program. The funding organisations had no involvement in the conduct of the study, and the authors are independent of the funding sources. All authors had access to the study data and were responsible for the decision to submit the paper for publication. Acknowledgements We are extremely grateful to all of the women taking part in the Maternal Health Study. 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