Theme 6: The contribution of qualitative methods in examining intervention

understanding outcomes. This chapter presents Theme 6- ‘The contribution of qualitative methods in examining intervention outcomes’.

8.2 Theme 6: The contribution of qualitative methods in examining intervention outcomes

Intervention providers reported that the tools administered to measure intervention outcomes (outlined in Chapter 3), only demonstrated a partial understanding of the impact of the interventions, “I don’t believe the tools that we’ve

been using adequately demonstrate the difference that has been made” (Simone). These

limitations were also evident when the data from these measures were compared with the interview data. One mother, Jackie, reflected that her participation in the qualitative interviews impacted how she viewed intervention effectiveness, “it [Intervention A]

helped a lot more than I actually thought, now I’ve been speaking about it”. This

suggests the importance of considering what methods are used to explore intervention outcomes and how this may impact perceptions about intervention effectiveness. The qualitative interviews enabled a richer understanding of intervention outcomes and are discussed in the following three subthemes:

 Subtheme 1: Prioritising the voice of the child  Subtheme 2: Situating outcomes in context

 Subtheme 3: Identifying unanticipated intervention outcomes 8.2.1 Subtheme 1: Prioritising the voice of the child

The qualitative study (Study 2) enabled children to share in their own language their experience of an intervention, in such a way that could not be captured through the outcome measures. The evaluation tools, as used in Study 1, appeared to mould the voice of the child into key thoughts and feelings. One intervention provider observed that Tool D did not prioritise the voice of the child as it limited the amount of feedback from the children, “it’s one-word answers isn’t it, but it’s not really what you want but it

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narratives of children allowed the voice of the child to frame their own meaningful outcomes of participating in an intervention.

Illustrating this, Penny thought she was to blame for the DVA incidents that occurred in her family, “I thought it was my fault, why my dad did that stuff”. From attending the intervention, she learned that “it isn’t my fault, that I’m not alone”. Penny described the impact of now understanding that it was not her fault, “I used to like wish I

died and all that… now I feel like I don’t want to kill myself anymore and I don’t want to run away…Now I feel happy…because it’s let go.” Penny also explained that during the

intervention she had begun to communicate her feelings with an animal puppet that she had ‘befriended’ at the intervention. Without this puppet she “wouldn’t have talked to

anyone... I would have done that [looked down] not talking, just sit quietly just listen to other people”. Upon leaving the intervention the facilitators gave Penny the animal

puppet to keep, which Penny reported that she used as a coping strategy outside the intervention environment, “I always whisper to it to him about how I feel about dad.”

From Cinderella’s perspective, hearing other children’s experiences of DVA had helped her realise that she was not “the only person” who had experienced it. This enabled her to appreciate her own family situation, “If you’d asked me before, I would

have been really sad and annoyed about it… if you’d ask me now, I’m happy? I’m happy with what I’ve got… when I listened to everyone else’s [experiences]… I was like… wow, people have worse families than me”. Cinderella felt that attending the

intervention was “probably the best 12 weeks of my life…. when my dad hit my mum it

was probably the worse 40 minutes of my life…so to know why he did it what happened and what it was and how to solve it if it actually happened again was good… that’s why it was the best 12 weeks of my life.” Through understanding her experience of DVA,

Cinderella reported that she grew to care about DVA, “when you’ve been through it, and

you’ve learned about it… you actually care what it is”, to the extent that she wanted the

opportunity to help other children to understand DVA and be equipped to know what to do if they faced a similar situation, “It would be nice to go into school one day we have

PSHE and they do… domestic abuse if it happens to someone else I would prefer if they knew what to do.”

As staff employed by the DVA organisation recognised that there were limitations associated with how outcomes were measured, the DVA organisation had been involved in developing an outcomes framework for all of the interventions provided across their organisation. Surprisingly, the DVA organisation had not directly consulted the children, but rather relied on their perceptions regarding what outcomes

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children were likely to perceive as being meaningful, “It wasn’t that we asked the

children… it was all the staff, and what they were doing is looking at what children want…putting yourself in their shoes, then putting yourselves in the facilitators shoes, then putting yourself in practitioners, then a manager’s and then a funder’s so you walk through all of those to come out with what [outcomes] you want” (Eleanor). Intervention

providers’ decision not to directly consult the children was reflected in other ways. For example, when introducing the child-led ‘Talking to my Mum’ book, facilitators reported that they did not “physically give it [the book] to the children, we give the book

physically to the adult… we don’t talk greatly to the child about it, so we tell them that there’s a book... whereas with the parents we do a session talking specifically about the book and how you know they can support the child...we don’t do that level of content...that detail... with the child… we don’t all sit down and have a look at a copy [with the children] together” (Eleanor).

8.2.2 Subtheme 2: Situating outcomes in context

The qualitative narratives highlighted that factors mediating intervention outcomes could not be accounted for using the outcome tools, as these did not situate outcomes in context. These will now be discussed using three examples.

8.2.2.1 Physically travelling to and from the intervention

The qualitative narratives demonstrated that the journey travelling to the intervention enabled Jackie and Kwaii-Chan to talk to each other and resulted in an improvement in their relationship. Jackie was the only parent who reported that this

“special time” each week helped to develop their relationship. Jackie welcomed this

opportunity as she found it difficult to spend time with each of her children, “trying to

take one out without the other is a bit hard… it would just be me and her going from school…and on the way, we’d stop off at the shop and get some sweets and a treat…that no one else had, so she enjoyed that because it was our one to one time.” However, once

the intervention had ended, Jackie said that their “special time obviously…stopped”. In this example, the intervention helped to create a context in which the mother-child relationship could develop. However, as a result of the intervention ending, this opportunity was removed. Thus, by Kwaii-Chan attending the intervention and Jackie transporting her, this enabled opportunities for their relationship to develop which were not necessarily accounted for by the tools used in Study 1.

8.2.2.2 Using an optional intervention resource

As part of Intervention A, the ‘Talking to my Mum’ resource aimed to support the rebuilding of the parent and child relationship through facilitating conversations

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about their experiences and feelings about DVA. However, facilitators had not followed- up how this book was actually being used and how it impacted the mother-child relationship, due to being mindful as to whether parents would respond to follow-up,

“we don’t do that follow up afterwards and see how much, and we know how much parents are given documents and books and letters and things” (Eleanor). However, the

qualitative interviews with children and mothers explored how this resource was being used in the home, how it could be beneficial, and identified the barriers to engaging with it.

Zoe reported that the book facilitated communication with Penny, “It helped me

understand her feelings a lot more… Before the programme, I only knew how she was feeling from her behaviour…” (Zoe). Using the illustration of a tree, Zoe described how

the book helped Penny communicate her thoughts and feelings to Zoe: “…I asked her

whereabouts she was on the tree… before she started this group… she was sitting on her own and I was sitting on the tree, she thought I was the stronger one on the tree…halfway through [the intervention] she said I was the one that was helping her up on the tree now and I was the one giving her the lift up and when she’d finished [the intervention] she said we were both sitting on the tree together”. In an interview with

Penny where Zoe was also present, Penny struggled to articulate her viewpoint. In response to this, Zoe suggested phrases that she believed might reflect what Penny wanted to say. Penny responded to Zoe’s help and said, “When I did that how come it

sounded confusing and when mum said it was not confusing?” Zoe believed that having

worked through the book with Penny, this facilitated her understanding of Penny, “I feel

like I knew what you were trying to say… doing the programme with you and the writing in the book I sort of know from that kind of thing what you mean.”

Kwaii-Chan reported that she appreciated working through the book with Jackie as it helped create a space that was for her and Jackie, “It was just for me and mummy to

do. I did some bits on my own but when I got stuck… on something like a word… mummy helped me”. From Jackie’s perspective, the book helped her better understand

how Kwaii- Chan felt, “I think there’s a lot in it [Talking to my Mum book] that parents

don’t think about… we had moved around a lot because of what had happened so there was one in there about leaving your home and your friends and how you felt… and she put down what she missed and what have you…learning things about your own kids that you don’t really know.” However, Jackie reported that her experience of working

through the ‘Talking to my Mum’ book posed a barrier that had not been raised by other mothers. Jackie explained the difficulties of engaging with this resource when coming

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across activities in the book that referred specifically to the DVA perpetrator, “there

were some bits we didn’t talk about in there because they were a bit raw over dad” and

therefore these activities were “avoided”.

In contrast, Cinderella did not want to engage with the ‘Talking to my Mum’ book for the reason that she perceived the book format of the resource as a barrier to engaging with it, compared to an electronic format, “I was like ok thanks for the book I

guess…I don’t find books fun.” Whilst this impacted the extent to which Naomi and

Cinderella used this resource, it did not create a barrier to developing their relationship,

“We’ve been talking a lot about different stuff and she is very open, she doesn’t say I don’t wanna talk, you know, she won’t hide herself away, she will come and talk to you”

(Naomi). Thus, understanding outcomes such as the improved mother-child relationship is important to locate and understand contextually.

8.2.3 Subtheme 3: Identifying unanticipated intervention outcomes

The findings from the qualitative interviews identified that there had been outcomes experienced by parents that had not been anticipated nor measured by intervention providers. However, this was somewhat inconsistent with intervention providers’ emphasis on the role of parents in supporting children through an intervention (as discussed in Chapter 6) which may inevitably lead to impacting the lives of parents. Parents whose child attended Intervention A, reported experiencing outcomes that related to their own developed understanding about DVA. Parents’ accounts varied about how their understanding of DVA had changed and what they believed had mediated this change. Jackie reported previously believing that DVA consisted only of physical abuse between parents, however through talking to Kwaii-Chan, her understanding developed, “I thought domestic violence was them watching mum and

dad beating each other up… but she [Kwaii-Chan] came out and explained all that to me.” Through communicating with Kwaii-Chan, Jackie also developed an awareness of

her children’s experiences of the DVA incidents that occurred in the family home that she had been previously unaware of, “I didn’t know the kids knew what was going on…

they were out of the way as far as I was concerned, they didn’t see or hear anything.”

Zoe reported that she had conversations with the facilitators to gain an understanding about “what is a violent relationship…what is a normal relationship…

the statistics of how high domestic violence is in the country”. Developing an

understanding of these things enabled Zoe to understand what she had personally experienced “…just the conversations with them [facilitators], has helped me

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Naomi explained that she had previously attended her own DVA recovery intervention prior to Cinderella attending the Intervention A. As a result, Naomi reported that she had gained an understanding of DVA through attending the intervention which had helped her “break things down of how they happen and how I might have felt at the

time but not really understood… just being able to accept it and acknowledge it and then just leave it behind”. Naomi did not report an improvement in her understanding of

DVA through Intervention A, but recognised the improvement was facilitated through previously attending an intervention for victim/survivors.