Violence in families mostly affects women and children. Cross-sectional surveys in General Practice show that the prevalence of family violence for women between 16–65 years of age is estimated at 30-41% [1–3]. The WHO defines family violence as any behaviour within an intimate relationship that causes physical, sexual or psychological harm, including acts of physical aggression, sexual coercion, psychological abuse and controlling behaviours. This definition covers violence by both current and former spouses and partners . The Netherlands Youth Institute (NJI) includes in their definition that other family members, including children, are, directly or indirectly, affected by the exposure to the violence and considers it as child abuse . In 2006, in 60% of the cases of family violence in Dutch women registered by the police, there were children living at home, and in most cases they were exposed to the violence against their mothers. This leads to an estimate of 15.340 children in the Netherlands exposed to family violence . In 2008, 23% of the contacts with the Dutch Child Abuse Authority (AMK) concerned exposure to family violence .
Family violence contributes to significant morbidity, such as depression and anxiety disorders . Children in families where violence occurs are in a very difficult position, often supporting the victim, trying to protect him or her, instead of being protected themselves. Their feelings and comprehension of ‘safety’ as well as their immediate safety are highly under pressure. Repeated subjection to violence and the interfamilial character increase the chance of developing mental health or behavioural problems. These children are as much at risk for long term negative consequences as children who are abused themselves. The consequences are diverse: mental health problems, such as affective and depressive disorders and suicide attempts, educational problems, such as school drop-out, behavioural problems, substance/drug abuse and risk taking behaviour. They also have a one-in-three chance of becoming either victim or abuser in their adult life. This is called intergenerational or transgenerational transmission [9–14]. Several theoretical models underlie these findings. Ehrensaft et al. and Carpenter & Stacks both give an extensive overview of these models, including the social learning theory of Bandura [11, 15, 16]. This theory states that children learn new behaviour by observing and imitating significant others, called modelling. If children are exposed to violence, they learn that violence is an acceptable or effective means of resolving conflicts with the partner. Other theories are the betrayal trauma theory  and the attachment theory: parenting stress can impact internalizing and externalizing behaviour and lead to increased stress and symptoms of posttraumatic stress disorder (PTSD) [18–20].
Family violence also influences reproductive and sexual health. A systematic review by Coker  addressed family violence and sexual health. Family violence was consistently associated with sexual risk taking, unplanned pregnancy or induced abortion, sexually transmitted disease (STD) and sexual dysfunction . There is hardly any research studying the consequences of exposure to family violence on reproductive and sexual health issues in children and adolescents. The few studies focusing on adolescents exposed to violence at home, found an association with sexual risk behaviour, having sex before age 15, multiple partners, having a STD, unplanned pregnancy, and alcohol/drug use in relation to sexual activities [9, 22–26].
In order to prevent intergenerational transmission, mental health problems and sexual/reproductive risk behaviour in adult life, it is important that early support for children, adolescents and young adults exposed to family violence is available. Support, however, is scarce. Most of the preventive interventions in the Netherlands are regional, do not offer specialized care or have a high threshold. Interventions specifically aimed at children and adolescents exposed to family violence are mostly group therapy. These interventions all require involvement and/or consent of parent(s), regular mental healthcare and/or need a referral from the GP or Child Protection agency. Knowing that these children often support their mother by trying to protect her, instead of being protected, they are not likely to seek help for themselves unless their mother is already receiving help [27, 28]. Unfortunately, women who face family violence are often too afraid to seek help and mothers with children at home are even more vulnerable since they try to protect their children. Trying to maintain the family, they do not leave the abusive partner in many cases. Above that, regular health services frequently fail to deliver appropriate support due to long waiting lists and because they do not meet women’s needs [29, 30]. The surroundings, abusers, mothers and GP’s are in most cases not aware of the long-term consequences of exposure to family violence for children . Therefore, children and adolescents exposed to family violence are difficult to reach. Moreover, evidence is lacking on the effects of preventive interventions and the possible role of primary health care .
To prevent intergenerational transmission and negative effects on reproductive and mental health, a low-threshold support method is needed for children, adolescents and young adults exposed to family violence. Children and adolescents of the current generation often rely on the internet as source of information and to maintain their social contacts. In the Netherlands, 93% of the children age 6–18 use the internet and 78% use social networking sites. Of the adolescents, age 12–18, 96% have a mobile phone. After contacting friends in real life, the internet and their mobile phone are the most important sources for adolescents age 12–18. A good website according to adolescents age 12–18, gives them reliable information, provides social support and is safe [32, 33]. Considering this, it is to be expected that children who are exposed to family violence will search for information on the internet. Although general information on sexual and reproductive health and general help, for example the ‘Kindertelefoon’ (‘Children’s telephone’: support for children by phone and chat), is available online, there is hardly any specific information on what to do. An internet-based self-support method can be a low-threshold method to give support. E-health is still a commencing method and most interventions available online are based on assumptions and literature instead of including the wishes, needs and demands of the target group. Because of constraints from ethical boards when it concerns minors, most of these interventions are not evaluated well. Peer support and peer education, however, are researched extensively and are nowadays recognized as effective methods to change behaviour [34–37]. Furthermore, social support has proven to be effective in adults exposed to violence and is associated with good mental and physical health outcomes [38, 39].
In 2011 “Young People, Adult worries” started with the development of a new internet-based self-support method for children, adolescents and young people exposed to family violence. Based on opinions from the target group, experts and literature, “Feel the ViBe (Violence Beaten)” was developed. “Feel the ViBe” is intended as a freely available, low-threshold stand-alone intervention for children, adolescents and young people who are exposed to family violence. The primary goals are to provide (peer)support and information. If “Feel the ViBe” is successful, this may have large impact on the traditional healthcare, possibly leading to more help offered and less costs.
This study protocol briefly describes the development of the intervention, which took place in 2011, followed by the protocol for the effectiveness study.
To explore knowledge about sexual and reproductive health in children, adolescents and young adults exposed to family violence.
To explore sexual risk taking behaviour in children, adolescents and young adults exposed to family violence.