Effects of nurse-led child- and parent-focused violence intervention on mentally ill adult patients and victimized parents: A randomized controlled trial.
BACKGROUND
Child-to-parent violence is an often hidden serious problem for parental caregivers of mentally ill adult children who experience violence toward them. To date, the comprehensive dyadic parent-adult child intervention to manage child-to-parent violence is scarce.


OBJECTIVE
To evaluate the effect of Child- and Parent-focused Violence Program, an adjunctive intervention involved with both violent adult children with mental illness and their victimized biological parent (parent-adult child dyads) on violence management.


METHODS
Open-label randomized controlled trial.


METHODS
A psychiatric ward in a teaching hospital and two mental hospitals in Southern Taiwan.


METHODS
Sixty-nine patients aged ≥20 years, with thought or mood disorders, having violent behavior in the past 6 months toward their biological parent of either gender were recruited. The violent patients' victimized biological parents who had a major and ongoing role in provision of care to these patients, living together with and being assaulted by their violent children were also recruited. The parent-adult child dyads were selected.


METHODS
The intervention was carried out from 2011 to 2013. The parent-adult child dyads were randomly assigned to either the experimental group (36 dyads), which received Child- and Parent-focused Violence Intervention Program, or to the control group (33 dyads), which received only routine psychiatric care. The intervention included two individualized sessions for each patient and parent, separately, and 2 conjoint sessions for each parental-child dyad for a total of 6 sessions. Each session lasted for at least 60-min. Data collection was conducted at 3 different time frames: pre-treatment, post-treatment, and treatment follow-up (one month after the completion of the intervention).


RESULTS
Occurrence of violence prior to intervention was comparable between two groups: 88.9% (n=32) parents in the experimental group versus 93.9% (n=31) in the control group experienced verbal attack, and 50% (n=18) versus 48.5% (n=16) received body attack and were injured. The intervention significantly reduced violence, improved impulsivity, changed patients' and parents' violence attributions, and fostering active coping processes in the experimental group as compared to the control group (p<0.05). No significant reductions were found in verbal aggression, cognitive and social reactions in the parent's reactions to assault, attentional subscale of impulsivity and wishful thinking (p>0.05).


CONCLUSIONS
Child- and Parent-focused Violence Intervention Program is effective on child-to-parent violence management in parent-adult child dyads. Thus, the intervention can be helpful for patients who have just been diagnosed with mental illness and had an episode of violence toward their parents within a narrow time frame.
Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan, ROC; Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC; Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC. Electronic address: gcsun39@yahoo.com.tw.
Gwo-Ching
GC
Sun
Department of Nursing, I-Shou University, Taiwan, ROC. Electronic address: hsu88@isu.edu.tw.
Mei-Chi
MC
Hsu
D000328:Adult; D017028:Caregivers; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009740:Nursing Staff; D010290:Parents; D013624:Taiwan; D014754:Violence / Q000517:prevention & control*; D055815:Young Adult
Child-to-parent violence; Mental illness; Nurse-led violence intervention; Nursing; Randomized controlled trial; Repetitive violence; Victimized parents