Trauma-informed art and play therapy: Pilot study outcomes for children and mothers in domestic violence shelters in the United States and South Africa

Background: While intimate partner violence (IPV) has well documented impact on women and children, few interventions have been tested for mothers and children in the domestic violence shelter system. Objective: We used mixed methods to explore effects of a pilot intervention combining trauma focused cognitive behavior therapy (TF-CBT) (verbal therapy method) with art and play therapy (non-verbal therapy methods) in New York City and Johannesburg, to compare efficacy between high and low-middle income contexts. Participants and setting: School-aged children and their mothers from one domestic violence shelter in each city were invited to participate. Methods: Children were screened for depression and post-traumatic stress disorder (PTSD). Children participated in a weekly group session lasting 1-2 hours over 12 weeks and mothers received 3 group sessions. Quantitative data comprised pre-and post-intervention child self -reports (n = 21) and mother's report (n = 16) of child depressive and PTSD symptoms. Qualitative in-depth interviews were conducted with children (n = 11) and mothers (n = 8) who completed the intervention. Results: At baseline, children showed high rates of symptoms of probable depression and probable PTSD (33 % and 66 % respectively). By endline, depressive symptoms significantly reduced (mean of 13.7-8.3,p = 0.01) and there was a non-significant trend towards PTSD improvement (40.0-34.4, p = 0.21). Children revealed the art helped them express difficult emotions and experiences with their mothers. Multiple children felt it assisted in managing challenging behaviours. Conclusion: This pilot trauma-informed art and play therapy group intervention holds promise in mitigating the effects of IPV for children and mothers in domestic violence shelters.