ORIGINAL ARTICLE
Jou nal o Family Violence (2023) 38:1273–1285
h ps://doi.o g/10.1007/s10896-022-00447-w
In oduc ion
You h- o-pa en agg ession (YPA) includes a pa e n o
agg essi e beha io by young people/child en who con-
sciously di ec agg ession owa d one pa en o ca egi e ,
epea edly o e ime, when he pe pe a o and he ic im
habi ually li e oge he (Ibabe, 2020). The e m agg es-
sion in eg a es mino agg ession and se e e mal ea men ,
while iolence is an ac o physical o ce ha causes o is
in ended o cause ha m. Thus, he e m used in his s udy
will be you h- o-pa en agg ession. Ne e heless, in he li -
e a u e o he e ms ha e been used, such as child- o-pa en
iolence, pa en abuse o iolence agains pa en s. The da a
a ailable on wo ld p e alence a es e ealed he 12-mon h
incidence o physical YPA pe pe a ed o be be ween 5%
and 21% in he communi y popula ion (Simmons e al.,
2018). In he Spanish con ex , he pe pe a ion a e o se e e
physical YPA was be ween 2% and 5% (Ibabe e al., 2020).
Howe e , i is necessa y o indica e ha p e alence a es o
Izaskun Ibabe
[email p o ec ed]
Aina a A noso
[email p o ec ed]
Edu ne Elgo iaga
[email p o ec ed]
1 Uni e si y o he Basque Coun y UPV/EHU, Donos ia-San
Sebas ián, Spain
2 Depa men o Clinical and Heal h Psychology and Resea ch
Me hodology, Uni e si y College o Psychology, Uni e si y
o he Basque Coun y UPV/EHU, A da. Tolosa 70,
20018 Donos ia-San Sebas ián, Spain
3 Depa men o Social Psychology, Uni e si y College o
Psychology, Uni e si y o he Basque Coun y UPV/EHU,
A da. Tolosa 70, 20018 Donos ia-San Sebas ián, Spain
Abs ac
Pu pose P ac i ione s in child and amily se ices a e able o iden i y cases o you h- o-pa en agg ession. The aim o
his s udy was o e alua e long- e m e ec s o he Ea ly In e en ion P og am in Si ua ions o You h- o-Pa en Agg ession
(EI-YPA), which was implemen ed in a Child en and Family Se ices con ex on he ou come a iables o adolescen s and
pa en s (indi idual beha io and heal h ou comes), indica ing he s eng h o he e idence.
Me hods The pa icipan s we e membe s o 39 Spanish amilies wi h child en be ween 12 and 17 yea s (N = 101; 40 adoles-
cen s and 61 pa en s) and a quasi-expe imen al design o epea ed measu es was applied. EI-YPA p o ides posi i e e idence
and expe iences based on he epo s o child en and pa en s. In o de o analyze whe he he imp o emen s we e clinically
ele an , a eliable change index was used.
Resul s Signi ican imp o emen s conce ning agg essi e beha io a home, clinical symp oms and amily con lic we e
ound. E ec sizes we e la ge o agg essi e beha io indica o s (agg essi e discipline d = 1.19; psychological YPA d = 0.93),
and dep essi e symp oma ology o adolescen s (d = 0.80).
Conclusion The posi i e changes ound indica e he long- e m e icacy o he EI-YPA on beha io al a iables and clinical
symp oms o child en and pa en s, as well as he amily con lic pe cep ion. This s udy con ibu es o inc easing he e idence
quali y o EI-YPA as a po en ial e idence-based p og am.
Keywo ds child- o-pa en iolence · clinical symp oms · amily con lic · in e en ion in child- o-pa en iolence ·
p og am e alua ion
Accep ed: 17 Sep embe 2022 / Published online: 2 No embe 2022
© The Au ho (s) 2022
Ea ly In e en ion P og am in You h- o-Pa en Agg ession: Clinically
Rele an long- e m Changes
IzaskunIbabe1,2 · Aina aA noso1,3· Edu neElgo iaga1,3
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Jou nal o Family Violence (2023) 38:1273–1285
YPA om di e en s udies a e some imes no compa able
because di e en ins umen s and/o c i e ia (ze o ole ance
s. echnical abuse; mild s. se ious agg ession) a e used o
assess YPA.
The e is abundan li e a u e ocus on iden i ying isk
ac o s o child en who pe pe a e YPA and hei amily
cha ac e is ics o explain he phenomena. When YPA is
se e e, male child en a e he mos equen pe pe a o s
o YPA (Moulds e al., 2018). The psychological p o ile o
adolescen s who ba e ed hei pa en s comp ises low sel -
es eem and empa hy (Cal e e e al., 2011), g andiosi y and
insu icien sel -con ol schemas (Fe nández-González e
al., 2022) and subs ance use (Ibabe e al., 2014; Johnson
e al., 2018). Mo eo e , hese adolescen s may o en ha e
dep essi e symp oms (Ibabe e al., 2014) and como bid
men al heal h p oblems (Moulds & Day, 2017). Some s ud-
ies ha e examined whe he pa en al discipline s a egies
a e ela ed o YPA, and he mos conclusi e esul s e e o
highly puni i e discipline (Ibabe & Ben le , 2016). Nega i e
amily en i onmen is one o he bes -known isk ac o s
o YPA, speci ically amily con lic , low le el o cohesion
(A ms ong e al., 2018; Con e as & Cano, 2014), exposu e
o ma i al iolence o pa en - o-child iolence (see me a-
analysis by Gallego e al., 2019). Fu he mo e, i should be
no ed ha mos o he commonly accep ed heo e ical expla-
na ions o YPA a e nega i e amily en i onmen o amily
b eakdown (Downey, 1997). As appea s ob ious, his ype
o iolence is no a p oblem exclusi ely o mino s, because
a he s and mo he s a e also imme sed in he p oblem since
i is a con lic ha happens a he amily le el. The e o e, i
would be in e es ing o include all amily membe s in he
in e en ion p og am, emphasizing his pe spec i e.
YPA In e en ion P og ams
Despi e ecogni ion o YPA as a c i ical p oblem acing am-
ilies, child and amily se ices, men al heal h p o essionals,
law en o cemen , and he ju enile jus ice sys em, speci ic
in e en ions a e sca ce (Ibabe e al., 2018; Nowakowski
& Ma e n, 2014) and lack a su icien amoun o empi ical
suppo (Ibabe e al., 2018; Toole-Ans ey e al., 2021). A
e iew o YPA in e en ions in di e en a eas (child p o-
ec ion sys em, men al heal h and ju enile jus ice sys em)
was ca ied ou (Ibabe e al., 2018). Six YPA ea men p o-
g ams we e iden i ied as ou s anding bu none a e e idence-
based p og ams because hey ha e no unde gone a igo ous
e alua ion p ocess and demons a ed e ec i eness. The
quali y o he in e en ion p og ams was analyzed aking
in o accoun he ollowing indica o s: he p o essional and/
o esea ch expe ience o he p og am de elope s in YPA,
accessibili y o ma e ials, good le el o p o ocoliza ion o
he p og am, e alua ion epo , and some e idence o hei
e ec i eness. Only h ee o in e en ion p og ams (Non io-
len Resis ance, Coogan & Laus e 2015; Ea ly In e en ion
P og am in Si ua ions o You h- o-Pa en Agg ession, Ibabe
e al., 2018; S ep-Up, Rou & Ande son, 2004) had p og am
e alua ion epo s, bu he s udies included we e o low
quali y. In he same way, in hei sys ema ic e iew, Toole-
Ans ey e al., (2021) indica ed ha he numbe o iden i ied
s udies on in e en ions in YPA was low and hey we e o
low quali y, acco ding o he Mixed Me hod App aisal Tool
(Pace e al., 2012).
Fu he mo e, o he bes o ou knowledge, he e is no
p og am a he le el o ea ly in e en ion wi h he excep ion
o he Ea ly In e en ion P og am in Si ua ions o You h-
o-Pa en Agg ession (EI-YPA) (Ibabe e al., 2019), ca ied
ou in he Child and Family Se ices o he Vi o ia-Gas eiz
Ci y Council (Spain) since 20171. The EI-YPA p og am has
he speci ici y cha ac e is ic o an E idence-Based P og am
(EBP) (Smi h, 2013): he in e en ion mus (1) be limi ed in
ime (i has a se numbe o sessions), (2) ha e manuals wi h
a de ailed p o ocol necessa y o implemen he in e en ion,
(3) ha e as objec i es well-de ined in e en ion p og ams
ha ocus on a pa icula p oblem, and (4) be aimed a a
speci ic a ge popula ion.
Desc ip ion o he EI-YPA P og am
The gene al objec i es o he p og am a e he educ ion o
agg essi e beha io in he amily and clinical symp oms, as
well as he imp o emen o he amily en i onmen , wi h
app op ia e s a egies es ablished o he esolu ion o con-
lic i e amily in e ac ions. This p og am includes se e al
heo e ical app oaches. I is a psycho-educa ional p og am
wi h a cogni i e-beha io al componen and g oup-based
he apy app oach (5–10 pa icipan s), aking sys emic am-
ily he apy echniques in o accoun o amily sessions ( o
mo e de ails see Ibabe e al., 2019). The a ge popula ion
is amily membe s whose child en ange in age om 12
o 17 yea s and p esen YPA. The p og am includes h ee
subp og ams (Adolescen s wi h 16 sessions, Pa en s wi h
11 sessions, and Families wi h 8 sessions), wi h each ses-
sion las ing 90 min. Adolescen s and pa en s ha e g oup
sessions in sepa a e spaces o lea ning compe ences and
s a egies, sha ing expe iences wi h pe sons in simila si u-
a ions. All membe s o each amily subsequen ly pu he
skills lea n in o p ac ice in he amily uni con ex unde
1 This p og am was p omo ed by he Child en and Family Se ices
o he Ci y Council o Vi o ia-Gas eiz (Spain). I was also adap ed and
ex ended aking in o accoun he needs o he communi y, based on
a pa icipa i e wo k p ocess led and coo dina ed om CFS by Loli
Ga cía Ga cía and Belén Cebe io Cuñado.
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Jou nal o Family Violence (2023) 38:1273–1285
he p ac i ione ’s supe ision. The in e en ion p og am
manual has 508 pages, in which he sessions a e explained,
wi h iming o e e y ac i i y and ecommenda ions o spe-
cial si ua ions. I also includes a wo kbook o pa icipan s
ha can be consul ed a home a any ime. In o ma ion abou
he p og am schedule is shown in Table 1.
The concep ual basis o his in e en ion emphasizes he
complexi y o he a iables in ol ed in he de elopmen
o YPA, and he in e ela ion o di e en le els in e ms o
YPA. The in luence o a wide ange o po en ial isk ac o s
ha ha e p e ious empi ical suppo de i ed om di e -
en ecological le els has been indica ed (Hoyo-Bilbao e al.,
2020). EI-YPA adop s B on enb enne ’s (1979) social-eco-
logical model o human de elopmen . Some mic osys em
le el (domes ic iolence exposu e, ine ec i eness in pa -
en s’ applica ion o discipline o use o se e e discipline)
and on ogenic le el (adolescen s’ impulsi i y, subs ance
abuse o con lic - esolu ion skills) isk ac o s o YPA a e
modi iable, and in e en ions a ge ing hem may he e o e
educe YPA.
Empi ical E idence o he EI-YPA P og am’s
E ec i eness
The numbe and quali y o he esea ch s udies a e wo
aspec s o e idence which should be aken in o accoun o
EBP selec ion. Fou s udies o da e p o ide e idence o he
e ec i eness o EI-YPA (A noso e al., 2021; Asla e al.,
2020; Ibabe e al., 2018, 2021) based on amilies o chil-
d en aged 12 o 17 yea s. Wi h he excep ion o one s udy
(A noso e al., 2021), hese ha e published he sho - e m
ea men e ec o he EI-YPA p og am in Spanish ami-
lies on he ou come a iables o child en and pa en s. These
s udies epo ed ha child en and pa en s p esen ed ewe
beha io al and emo ional p oblems a e in e en ion. Spe-
ci ically, he EI-YPA p og am is an e ec i e in e en ion o
educing physical and psychological YPA and dep essi e
symp oma ology ou comes ( us a ion ole ance, a oidance
p oblems and highe sel -es eem) be ween he p e-in e en-
ion and pos -in e en ion (six mon hs s a ing in e en ion
p og am) (A noso e al., 2021; Asla e al., 2020; Ibabe e al.,
2018, 2021). The dec ease o ex e nalizing and in e nalizing
beha io o child en and pa en s would e lec he EI-YPA
p og am’s sho - e m e ec i eness.
P e ious s udies ega ding EI-YPA e alua ion ha e wo
impo an limi a ions. Fi s , he e ec s o his in e en ion
p og am in he long e m ha e ha dly been s udied. Second,
he small sample size o hese s udies caused hem o ha e
low s a is ical powe , making i impossible o know he ue
e ec o he p og am. I would he e o e be in e es ing o
analyze wha happened one yea a e s a ing he in e en-
ion p og am, o o wha ex en YPA, clinical symp oms o
all pa icipan s (adolescen s and pa en s), and amily con-
lic imp o ed o i esul s emained s able in he six-mon h
ollow-up e alua ion. I one p og am showed ha changes
in he pa icipan ’s a i udes, knowledge o beha io s we e
no pe manen a e p og am pa icipa ion had ended, hen
he e ec s would no be sus ainable and i would he e o e be
inadequa e (Ebbole, 2007). Al hough he pa e n o educed
iolen beha io and emo ional p oblems o child en and
pa en s a e in e en ion e lec s he EI-YPA p og am’s
Table 1 Schedule o he de elopmen o he p og am
Week Module Adolescen
sub-p og am
(16 sessions)
Family
sub-p og am
(8 sessions)
Pa en sub-
p og ams
(11
sessions)
1 Iden i ying
p oblem
1.P og am
p esen a ion
22.Diagnosis
o he amily
ela ional
sys em
3 A1 P1
4 A2 P2
5 Unde s anding
iolence
A3 P3
6 A4 P4
73. Take a ime
ou
8 Though s and
belie s abou
iolence
A5 P5
9 A6 P6
10 A7
11 Emo ional
managemen
A8 P7
12 A9
13 A10
14 A11 P8
15 Communica-
ion skills
and con lic
esolu ion
A12 P9
16 A13 P10
17 A14
18 4. Family
p oblem
sol ing
19 S eng hening
o change
A15 P11
20 A16
21 5. Asse i e
communica-
ion and
limi s in he
amily con ex
22 6. Changes
and epai
in he amily
con ex
23 7. Posi i e
and nega i e
emo ions in
he amily
24 8. Wha ha e
we changed?
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2. Adolescen s will show a lowe le el o clinical symp-
oms (dep essi e symp oms and emo ional ins abili y)
and i a ional belie s, as well as highe empa hy and li e
sa is ac ion one yea la e , aking in o accoun p e ious
sho - e m indings ega ding i a ional belie s o ado-
lescen s (Ibabe e al., 2021), dep essi e symp oms and
empa hy (Ibabe e al., 2018).
3. Agg essi e discipline by a he s and mo he s will be
lowe one yea la e . This esul is expec ed gi en he
la ge e ec size ound in he long e m in a p e ious
s udy (A noso e al., 2021).
4. Mo he s and a he s will p esen a lowe le el o clini-
cal symp oms (dep essi e symp oms and psychological
in lexibili y) and highe empa hy. This hypo hesis is
based on a p e ious s udy which indica ed ha dep es-
si e symp oms dec eased in he long- e m (A noso e
al., 2021), and in ano he s udy all amily membe s
showed a highe le el o empa hy a e in e en ion
(Ibabe e al., 2018).
5. All amily membe s will also pe cei e a lowe le el o
amily con lic , as ound in some p e ious s udies on
sho - e m ou comes o EI-YPA (A noso e al., 2021;
Asla e al., 2020; Ibabe e al., 2021).
Me hod
Design and E alua ion
In he cu en s udy, a quasi-expe imen al design o
epea ed measu es (p e, pos and ollow-up) was applied,
which includes wo a emp s o demons a e an in e en-
ion e ec . This design allows he moni o ing o changes
wi hin pa icipan s h ough compa ison be ween phases:
p e-in e en ion (be o e beginning he in e en ion), pos -
in e en ion (immedia ely a e inishing he in e en ion)
sho - e m e icacy, i is impo an o con inue assessmen
o he long- e m e ec s on amily membe s, including mo e
clinical indica o s such as psychological in lexibili y o
emo ional ins abili y. A p e ious s udy based on 33 pa en s
(A noso e al., 2021) ound a one-yea posi i e e ec o
inapp op ia e discipline and dep essi e symp oma ology,
wi h la ge e ec size. In gene al, YPA p og ams a e needed
ha p o ide mo e solid e idence o long- e m ollow-up
da a on ou comes and ecidi ism a es.
Objec i es
The main objec i e o his s udy was o analyze he long-
e m e ec s o he EI-YPA p og am (Ibabe e al., 2019), on
he ou come a iables o adolescen s and pa en s, indica -
ing he s eng h o he e idence (weak, medium o s ong),
and whe he hese changes we e clinically ele an . Recen
esea ch on clinical s udies ecommends ha esea che s
conduc ing clinical s udies epo he le el o s a is ical
signi icance o indi idual change esul ing om ea men
(Hays & Peipe , 2021). In he p esen s udy, a long- e m
e ec is conside ed when he ollow-up is a leas six mon hs
a e he conclusion o a p og am (one yea a e s a ing
he p og am), based on a me a-analysis o he sho - e m
and long- e m e icacy o psychological he apies (Lai d
e al., 2016). Hypo heses based on long- e m e ec s we e
p oposed:
1. Bo h physical and psychological YPA di ec ed a a he s
and mo he s will be lowe one yea a e s a ing he
p og am, acco ding o p e ious indings on sho - e m
e ec s (A noso e al., 2021; Asla e al., 2020; Ibabe e
al., 2018, 2021); i was expec ed ha hese changes
would be main ained in he long e m.
Fig. 1 E alua ion design o he s udy. (No e: E alua ion p o ocol (YPA, pa en al discipline, clinical symp oms, li e sa is ac ion, and amily
con lic );a: hese esul s a e p esen ed in Asla e al. (2020) and Ibabe e al. (2021))
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o he p og am olun a ily o did no mee he p og am’s
minimum a endance equi emen . O he 61 pa en s, se en
did no comple e he p og am, wi h a pa en al d opou a e
o 11% (7/61). Fou pa en s le he p og am olun a ily,
while h ee o he s we e e e ed o ano he se ice due o
he se iousness o he amily p oblem. The o e all d opou
a e aking in o accoun all pa icipan s was 15% (15/101),
which means ha adhe ence o ea men was 85% (86/101).
In o ma ion on he cha ac e is ics and p o iles o he pa ici-
pan s who s a ed he p og am can be ound in Table 2.
and ollow-up (six mon hs a e inishing he in e en ion o
one yea a e s a ing he p og am) (see Fig. 1). The ins u-
men s applied we e s anda dized scales wi h accep able
psychome ic cha ac e is ics. When he o iginal language
o he ins umen was no Spanish, an ins umen adap ed
and alida ed o he Spanish popula ion, and published
p e iously, was used. The ini ial e alua ion o adolescen s
and pa en s included p elimina y ques ions o assess inclu-
sion and exclusion c i e ia. Child en and Family Se ices
specialis s o e ed amilies he oppo uni y o pa icipa e
in he p og am, a e e i ying ha hey ul illed he inclu-
sion c i e ia in a semi-s uc u ed in e iew. The inclusion
c i e ia we e based on wo aspec s: (1) mild o mode a e
agg ession o child en owa d he a he o mo he (psycho-
emo ional o speci ic inciden s o physical YPA) and, (2)
pa en al inabili y o con ol agg essi e beha io in any con-
ex acco ding o he BALORA ins umen (A uaba ena,
2011). Exclusion c i e ia we e se ious physical agg ession
o one pa en (gi en ha he in e en ion p og am’s ocus
is on ea ly in e en ion in YPA), no being able o speak
Spanish luen ly, being he pe pe a o o in ima e pa ne
iolence, o se e e cases o child abuse. Those who decided
o pa icipa e in he p og am we e called o do a p e-in e -
en ion e alua ion. An applied psychology uni was con-
ac ed o implemen he p og am, and six he apis s and a
coo dina o conduc ed he in e en ion.
Pa icipan s
A he beginning o he p og am, 39 amilies li ing in Spain
wi h sons and daugh e s be ween 12 and 17 yea s o age
we e willing o pa icipa e. These amilies we e made up
o 40 adolescen s (26 sons and 14 daugh e s) and 61 pa -
en s (39 mo he s and 22 a he s) (N = 101). Al hough i
should also be no ed ha siblings pa icipa ed in he am-
ily sessions, hey we e no included in he e alua ion. Two
mo he s excep ionally a ended he subp og am o a he s/
mo he s wi hou hei sons o daugh e s pa icipa ing in he
p og am and hey we e coun ed as amily. Fu he mo e, wo
mo he s we e a couple om he same amily and wo o he
adolescen s also belonged o he same amily, because hey
we e wins. In his s udy, p og am comple ion s a us was
a ained when a endance was highe han 62% because in
each subp og am pa icipan s had o comple e a su icien
numbe o sessions o ha e some e ec (Adolescen 10 ou
o 16 sessions; Pa en 7 ou o 11 sessions, and Family 5 ou
o 8 sessions).
O he 40 adolescen s who s a ed he p og am, eigh did
no comple e i , esul ing in an o e all d opou a e o 20%
(8/40). Th ee adolescen s we e e e ed o ano he se ice
because YPA inc eased o a highe le el o se e i y in he
cou se o he p og am, and i e adolescen s d opped ou
Table 2 Socio-demog aphic cha ac e is ics o pa icipan s in p og am
e alua ion
Child en (n = 40)
Child gende n (%)
Male 26 (65%)
Female 14 (35%)
Child o igin n (%)
Spanish 28 (85%)
Immig an 5 (15%)
Child age [M (SD)] 14.41 (1.59)
Numbe o siblings [M (SD)] 2.24 (1.46)
Unexcused absences om school 18 (50%)
P oblems wi h he police o domes ic iolence
P oblem wi h he police o o he easons
8 (22%)
11 (31%)
Families (n = 39)
Family income (Eu os pe mon h) n (%)
Less han 1,000 € 8 (20%)
Be ween 1,000–2,000 € 10 (26%)
Be ween 2,000–3,000 € 10 (26%)
Mo e han 3,000 € 11 (28%)
Family s uc u e n (%)
Two biological pa en s 17 (43%)
Pa en s sepa a ed o di o ced 17 (43%)
O he ype o s uc u e 3 (8%)
Any pa en died 2 (5%)
Pa en s (Fa he s n = 22; Mo he n = 39)
Fa he educa ion le el n (%)
Elemen a y educa ion 6 (26%)
P o essional aining/ seconda y educa ion 12(53%)
Uni e si y educa ion 4 (21%)
Fa he employmen s a us n (%)
Employed 20 (90%)
Unemployed 0 (0%)
Re i ed/pensione 2 (10%)
Mo he educa ion le el n (%)
Elemen a y educa ion 9 (24%)
P o essional aining/ seconda y educa ion 18 (46%)
Uni e si y educa ion 12 (30%)
Mo he employmen s a us n (%)
Employed 30 (76%)
Unemployed 6 (16%)
Social help 3 (8%)
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Jou nal o Family Violence (2023) 38:1273–1285
Cal e e 2004). This in en o y included one scale o I a-
ionali y and six subscales o i a ional belie s: Need o
App o al/Success, Helplessness, Blame P oneness, A oid-
ing P oblems, In ole ance o F us a ion, and Jus i ica ion
o he Use o Violence. This ins umen has 37 i ems (e.g.,
Some imes you ha e o hi someone because hey dese e
i ), which a e answe ed in deg ees o ag eemen . Global
in e nal consis ency was excellen (p e-in e en ion α = .88;
ollow-up α = .86).
Emo ional Ins abili y (Adolescen epo ) (Emo ional
Ins abili y Scale, Cap a a & Pas o elli 1993; Del Ba io e
al., 2001). This scale measu es he lack o sel -con ol in
social con ex as a esul o poo abili y o es ain impulsi -
i y and emo ionali y. I includes 20 i ems (e.g., I help my
classma es o do hei homewo k). In his s udy, in e nal
consis ency was accep able (p e-in e en ion α = .68; ol-
low-up α = .72).
Dep essi e symp oma ology (Adolescen epo ) (Chil-
d en’s Dep ession Scale, CDS, Lang & Tishe 2014). CDS
was applied o measu e adolescen s’ dep ession symp oms,
o which h ee subscales we e selec ed (a ec i e esponse,
social p oblems and sel -es eem) wi h 24 i ems (e.g., I o en
eel lonely). In he cu en s udy, in e nal consis ency was
excellen (p e-in e en ion α = .93; ollow-up α = .97).
Empa hy (Pa en and adolescen epo s) (In e pe -
sonal Reac i i y Index IRI, Da is 1980; Spanish adap a-
ion, Pé ez-Albéniz e al., 2003). This scale measu es ou
dimensions o disposi ional empa hy, bu in his s udy only
wo subscales we e used: he Empa hic Conce n (7 i ems)
measu es emo ional empa hy, o eelings o compassion o
o he s in dis ess (e.g., I would desc ibe mysel as a ai ly
sensi i e pe son); and he Pe spec i e Taking (9 i ems) mea-
su es cogni i e empa hy, o he endency o see he wo ld
om o he s’ iewpoin s (e.g., Be o e c i icizing someone,
I y o imagine how I would eel i I we e in hei place).
In e nal consis ency was accep able o o e all (p e-in e -
en ion α =.79; ollow-up α = .77) and o empa hic conce n
(p e-in e en ion α = .73; ollow-up α = 0.71). Howe e ,
pe spec i e aking showed alpha coe icien s sligh ly lowe
(p e-in e en ion α = .69; ollow-up α = .68).
Sa is ac ion wi h li e (Pa en and adolescen epo s)
(SWLS, Diene e al., 1985; Spanish adap a ion by A ienza
e al., 2000). The scale consis s o i e i ems (e.g., I am sa -
is ied wi h my li e) agains which pa icipan s mus signal
hei le el o ag eemen o disag eemen on a 5-poin Like -
ype scale. In e nal consis ency o his ins umen o e all
was excellen (p e-in e en ion α =.84; ollow-up α = .89).
Family con lic (Pa en and adolescen epo s) (Family
En i onmen Scale, FES; Moos & Moos 1981; Spanish e -
sion, TEA Ediciones 1984). I ems o he subscale on amily
con lic ( he amoun o openly exp essed ange and con lic
among amily membe s) we e selec ed (e.g., In ou amily
Va iables and Ins umen s
In o de o homogenize he answe o ma in all ins umen s,
a i e-poin Like scale was applied. Measu es o iolen
beha io (Adolescen Child- o-Pa en Agg ession Ques-
ionnai e and Agg essi e Discipline) a e based on he e-
quency wi hin he las yea using ollowing scale (1 = Ne e ,
2 = Ra ely, 3 = Some imes, 4 = O en, 5 = Ve y o en).
You h- o-pa en agg ession (Pa en epo ) (Adoles-
cen Child- o-Pa en Agg ession Ques ionnai e, Cal e e e
al., 2013). The scale assessed physical and psychological
agg ession agains pa en s wi h 10 i ems based on he las
yea o li ing oge he (physical 3 i ems and psychological
7 i ems) (e.g., You ha e been insul ed o swo n a by you
son/daugh e ). This scale, answe ed by pa en s, showed an
accep able in e nal consis ency o physical iolence (p e-
in e en ion α = .75; ollow-up α = .75) and o psychologi-
cal iolence (p e-in e en ion α = .77; ollow-up α = .85).
Agg essi e discipline (Pa en epo ) (Dimensions o
Discipline In en o y DDI-C, S aus & Fauchie 2007; Span-
ish adap a ion, Cal e e e al., 2010). Al hough his in en o y
measu es ou gene al dimensions, he p esen s udy only
measu ed co po al punishmen and psychological agg es-
sion by he pa en in hei ela ionship wi h hei son o
daugh e . Each subscale had ou ques ions (e.g., How o en
did you shake o g ab you child en o ge his/he a en-
ion?). In his s udy, in e nal consis ency was accep able o
co po al punishmen (p e-in e en ion α = .89; ollow-up
α = .98) and o psychological agg ession (p e-in e en ion
α = .79; ollow-up α = .86).
Dep essi e symp oma ology (Pa en epo ) (B ie
Symp om In en o y, BSI-18, De oga is 2001). This scale
was de eloped o measu e he mos p e alen psychopa hol-
ogy symp oms in clinical, medical and communi y popu-
la ions. As o iginally cons uc ed, BSI-18 consis s o h ee
ac o s ha include soma iza ion (e.g., Fain ness o dizzi-
ness), dep ession (e.g., Feeling no in e es in hings), and
anxie y (e.g., Feeling ense o keyed up). A global se e i y
index can be calcula ed, which is he ull-scale sco e ac oss
he h ee ac o s. Highe sco es indica ing mo e dis ess du -
ing he p e ious week. This scale showed excellen in e nal
consis ency (p e-in e en ion α = .95; ollow-up α = .94).
Psychological in lexibili y (Pa en epo ) (Accep ance
and Ac ion Ques ionnai e-II, AAQ-II; Bond e al., 2011).
Psychological lexibili y and accep ance a e key concep s o
Accep ance and Commi men The apy (Spanish adap a ion
o Ruiz e al., 2013). I comp ises 7 i ems (e.g., Emo ions
cause p oblems in my li e). In his s udy, in e nal consis-
ency o his scale was excellen (p e-in e en ion α = .92;
ollow-up α = .93).
I a ional belie s o child en (Adolescen epo ) (I a-
ional Belie s In en o y o adolescen s, Ca deñoso &
1 3
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Jou nal o Family Violence (2023) 38:1273–1285
27 s a is ical package. No ea men o missing alues was
made. Fi s , basic assump ions we e es ed o - es analy-
ses o ela ed samples (su icien numbe o obse a ions,
no mal dis ibu ion, equal a iances). In o de o e alua e
long- e m e ec s, he p e-in e en ion and ollow-up da a
we e compa ed by applying pai ed-samples - es , and he
e ec size o a pai ed-samples - es was calcula ed. E ec
sizes (Cohen’s d) a e in e p e ed as small, medium and
la ge e ec (0.20, 0.50, and 0.80) (Cohen, 1988). The p o-
cess o de ining clinical signi icance emains a challenge.
Dis ibu ion-based me hods a e used o e alua e clinical el-
e ance (A mijo-Oli o e al., 2011) and a e based on he s a-
is ical dis ibu ion and he psychome ic p ope ies o he
ou comes, such as he e ec size o Reliable Change Index
(RCI). RCI is a common me hod o e alua ing he s a is i-
cal eliabili y o a di e ence sco e be ween wo obse a-
ions om he same indi idual and is widely applied o
de e mine clinically signi ican change in men al heal h and
beha io al ou comes (Fe guson e al., 2002). This index was
o iginally o mula ed by Jacobson e al. (1984) and e ised
by Ch is ensen & Mendoza (1986):
RC
I=
(X
2
−X
1
)
2
S1√1
−
xx
2
Whe e X1 and X2 a e he obse ed ou comes o one indi-
idual a imes 1 and 2; xx is a eliabili y coe icien (α1);
and S1 is a s anda d de ia ion. The en i e denomina o is
also called he s anda d e o o he di e ence sco e. A sco e
o a leas |1.96| indica es ha he indi idual change is s a-
is ically signi ican wi h 95% con idence; ha is, i was
unlikely o be due o measu emen e o .
Resul s
Resul s a G oup Le el
Child en: You h- o-pa en Agg ession, Clinical Symp oms
and Family Con lic
In o ma ion ega ding YPA is based on pa en epo while
he in o ma ion o es o a iables co esponds o child
epo . As shown in Table 3, he dec ease be ween p e-in e -
en ion and ollow-up was signi ican o : physical agg es-
sion owa d a he and/o mo he ( = 2.90, d = 44, p = .003),
psychological agg ession owa d a he and/o mo he
( = 6.26, d = 44, p < .001), dep essi e symp oma ology
( = 3.40, d = 17, p = .003), i a ional belie s ( = 3.33, d = 17,
p = .004), emo ional ins abili y ( = 3.46, d = 17, p = .003)
and amily con lic ( = 2.43, d = 17, p = .026). In addi ion,
we igh a lo ). This subscale con ains 9 i ems wi h a ue/
alse esponse o ma . The in e nal consis ency was accep -
able conside ing ha his scale has e e se sco e i ems (p e-
in e en ion α = .67; ollow-up α = .68).
Socio-demog aphic da a and men al heal h p ob-
lems (Pa en s and adolescen epo s). A ques ionnai e was
applied o assess socio-demog aphic a iables (sex, age and
coun y o o igin) o he child en and pa en s. Mo eo e ,
pa en epo s included o he cha ac e is ics such as am-
ily s uc u e, pa en al educa ion le el (none, compulso y
educa ion, u he educa ion/job aining o uni e si y), and
amily income.
P ocedu e
The design and conduc o he s udy, including he ques-
ionnai e, we e examined and app o ed by he E hics Com-
mission o he Uni e si y o he Basque Coun y UPV/
EHU (M10-2019-142). The s a o he municipal social
se ices con ac ed he amilies o hei possible pa icipa-
ion in he p og am. Pa en s p o ided hei in o med con-
sen and ha o hei child en be o e pa icipa ion in his
p og am. Mo eo e , child en signed hei in o med consen .
The e alua ions we e pe o med in a la ge oom in which
a physical dis ance be ween he pa icipan s was ensu ed
o gua an ee p i acy. The da a o all pa icipan s we e used
anonymously. The e alua ion p o ocol was applied by psy-
chologis s no connec ed wi h he in e en ion and ained
by he esea ch eam o conduc he e alua ion. They we e
no awa e o he hypo heses and s udy a iables. In he p e-
in e en ion e alua ion, each amily was called, while in he
pos -in e en ion and ollow-up e alua ion hey we e called
by wo k g oup (adolescen s and pa en s). The implemen-
a ion o he p og am was ca ied ou in i e in e en ion
g oups ca ied ou a i e ime poin s be ween Ma ch 2017
and Oc obe 2020.
Da a Analysis
Pa icipan s who did no inish he p og am wi h a minimum
a endance o 62% (n = 15) o did no comple e wo e alu-
a ion p o ocols (p e-in e en ion and ollow-up e alua ion)
(n = 23) we e excluded om da a analysis. Thus, he da a
analyses we e ca ied ou wi h 63 pa icipan s (18 adoles-
cen s and 45 pa en s, o which 16 we e a he s and 29 we e
mo he s). The esponse a e o p e-in e en ion was 100%,
as could be expec ed, bu ollow-up a e was somewha
lowe (87%).
Da a de i ed om clinically ele an esea ch on psycho-
logical p ac ices should be based on easonable e ec sizes,
s a is ical and clinical signi icance (APA, 2006). All s a is i-
cal analyses we e pe o med wi h he IBM SPSS S a is ics
1 3
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Jou nal o Family Violence (2023) 38:1273–1285
adolescen s showed signi ican ly mo e sa is ac ion wi h li e
( = -3.40, d = 17, p = .003), bu empa hy did no each sig-
ni icance ( = -1.98, d = 17, p = .064). The e ec sizes o
adolescen s anged om a la ge e ec o clinical symp-
oms such as psychological agg ession owa d a he and/
o mo he (d = 0.93), dep essi e symp oma ology (d = 0.80),
o i a ional belie s (d = 0.79), o a medium e ec o amily
con lic (d = 0.57), emo ional ins abili y (d = 0.52), empa hy
(d = -0.45), and sa is ac ion wi h li e (d = -0.43).
Pa en s: Agg essi e Discipline, Clinical Symp oms and
Family Con lic
The dec ease be ween p e-in e en ion and ollow-up (see
Table 4) was signi ican o agg essi e discipline ( = 7.99,
d = 44, p < .001), dep essi e symp oma ology ( = 4.09,
d = 44, p < .001), psychological in lexibili y ( = 3.42, d = 43,
p = .02), and amily con lic ( = 5.79, d = 44, p < .001). In
addi ion, pa en s showed signi ican ly mo e empa hy ( =
-2.36, d = 44, p = .025), and sa is ac ion wi h li e ( = -2.24,
d = 44, p = .030). A la ge e ec was ound o agg essi e dis-
cipline (d = 1.19) and amily con lic (d = 0.86). In gene al,
he e ec sizes o pa en ou comes we e medium: dep es-
si e symp oma ology (d = 0.61), psychological in lexibili y
(d = 0.52), empa hy (d = -0.43) and li e sa is ac ion (d =
-0.33).
Table 3 Mean compa isons be ween p e-in e en ion and ollow-up
e alua ions o psychological a iables o child en, wi h s anda d
de ia ion in pa en heses
Va iables P e-in e en ion Follow-up d
You h- o-pa en
agg ession ª
2.52 (0.56) 2.17
(0.82)
2.60* 0.89
Physical agg es-
sion a he ª
1.71 (0.75) 1.44
(0.64)
1.32 0.33
Physical agg es-
sion mo he ª
1.85 (0.65) 1.46
(0.64)
2.61* 0.48
Phy. agg. bo h
pa en s ª
1.65 (0.35) 1.30
(0.30)
2.57* 0.30
Phy. agg. a he
and/o mo he ª
1.80 (0.71) 1.45
(0.65)
2.90** 0.43
Psychol. agg es-
sion a he ª
3.04 (0.59) 2.16
(0.70)
3.40** 1.20
Psychol. agg es-
sion mo he ª
3.34 (0.59) 2.53
(0.69)
4.44** 0.82
Psy. agg. bo h
pa en s ª
2.37 (0.46) 2.00
(0.71)
2.37* 0.35
Psy. agg. a he
and/o mo he ª
3.23 (0.60) 2.40
(0.77)
6.26*** 0.93
Dep essi e
symp oma ology
2.26 (0.74) 1.80
(0.78)
3.40* 0.80
Sel -es eem 2.49 (0.89) 1.92
(0.89)
3.08* 0.73
A ec i e
esponse
2.06 (0.78) 1.96
(0.66)
2.63* 0.62
Social p oblems 2.24 (0.80) 1.79
(0.92)
2.60* 0.61
I a ional belie s 2.51 (0.45) 2.21
(0.46)
3.33** 0.79
Need o app o al 2.12 (0.81) 2.04
(0.70)
0.57 0.13
Helplessness 2.54 (0.58) 2.25
(0.48)
2.28* 0.54
Blame p oneness 3.43 (0.57) 3.03
(0.88)
1.66 0.39
A oiding p oblem 2.35 (0.74) 2.03
(0.73)
1.85 0.44
In ole ance
us a ion
2.94 (0.89) 2.59
(0.79)
1.26 0.30
Jus i ica ion use
iolence
2.17 (0.75) 1.83
(0.69)
2.45* 0.58
Emo ional
ins abili y
2.86 (0.63) 2.48
(0.59)
3.46** 0.52
Empa hy 3.15 (0.73) 3.27
(0.85)
-3.40 -0.45
Empa hic conce n 3.12 (0.88) 3.31
(0.73)
-1.60 -0.21
Pe spec i e aking 3.17 (0.80) 3.40
(0.77)
-1.40 -0.39
Sa is ac ion wi h
li e
2.81 (0.75) 3.27
(0.85)
-3.40** -0.43
Family con lic 5.44 (2.04) 4.28 (2.16) 2.43* 0.57
No e: a: All measu es ega ding you h- o-pa en agg ession a e based
on pa en epo ( a he s n = 16; mo he s n = 29) while ha he es
o a iables a e based on child epo (n = 18); Phy. agg.: Physical
agg ession; Psy. Agg.: Psychological agg ession; *: p < .05; **: p < .01;
***: p < .001
Table 4 Mean compa isons be ween p e-in e en ion and ollow-
up e alua ions o psychological a iables o pa en s and hei am-
ily en i onmen pe cep ion, wi h s anda d de ia ion in pa en heses
(n = 45)
Va iables P e-in e en ion Follow-up d
Agg essi e
discipline
2.27 (0.51) 1.63
(0.45)
7.99*** 1.19
Co po al
punishmen
1.69 (0.46) 1.24
(0.38)
5.36*** 0.80
Psychological
ag ession
2.85 (0.69) 2.02
(0.67)
7.51*** 0.79
Clinical
symp oms
Dep essi e
symp oma ology
2.26 (0.51) 1.87
(0.45)
4.09** 0.61
Psychological
in lexibili y
2.71(0.82) 2.40
(0.73)
3.42* 0.52
Empa hy 3.52 (0.42) 3.66
(0.39)
-2.36* -0.43
Empa hic conce n 3.70 (0.58) 3.76
(0.60)
-0.64 -0.12
Pe spec i e
aking
3.35 (0.51) 3.56
(0.46)
-2.481* -0.45
Sa is ac ion wi h
li e
2.66 (0.93) 2.93
(0.99)
-2.24* -0.33
Family con lic 4.80 (2.05) 3.24 (1.84) 5.79**** 0.86
No e:*: p < .05; **: p < .01; ***: p < .001
1 3
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Jou nal o Family Violence (2023) 38:1273–1285
owa d pa en s showed a medium e ec size (d = 0.43). A
la ge pe cen age o child en p esen ed no clinical changes
wi h espec o physical agg ession owa d a he (86%) o
agg ession owa d mo he (87%). Physical agg ession migh
be mo e di icul o change han psychological YPA o wo
easons. Fi s , he le el o physical agg ession was low in
he p e-in e en ion assessmen due o he p og am being
o ea ly in e en ion, wi h se ious physical agg ession o
one pa en a c i e ion o exclusion. Second, he cases ha
e ol e owa ds g ea e se e i y we e e e ed o YPA in e -
en ion p og am, which depends on ano he se ice.
P e ious s udies on e alua ions o EI-YPA ha e also
shown sho - e m e ec s a e mo e ele an in psychologi-
cal YPA han physical YPA (A noso e al., 2021; Asla e al.,
2020; Ibabe e al., 2018, 2021). This inding is impo an
because he a ge o his p og am is YPA, he numbe o
pa icipan s o he p esen s udy is highe and long- e m
e ec s a e explo ed. All s udies e alua ing he EI-YPA p o-
g am show ha he e is e idence in a o o he dec ease o
YPA, bu physical agg ession owa d a he s could be mo e
di icul o change; a leas he e idence is no clea and a
la ge sample size is equi ed. Mo eo e , a indi idual le el,
clinically ele an changes we e ound o physical agg es-
sion ( owa d a he s 13%, owa d mo he s 17%) and psy-
chological YPA ( owa d a he s 50%, owa d mo he s 52%).
As hypo hesized, adolescen s showed a lowe le el o
clinical symp oms and i a ional belie s, as well as highe
empa hy and li e sa is ac ion. A g oup le el, s a is ically
signi ican educ ions we e ound in some in e nalizing
beha io s, wi h e ec sizes anging om la ge (dep es-
si e symp oma ology d = 0.80; i a ional belie s d = 0.79)
o medium (emo ional ins abili y, d = 0.52), bu empa hy (d
= -0.45) and sa is ac ion wi h li e (d = -0.43) showed an
inc ease wi h medium e ec sizes. All hese esul s indica e
an imp o emen o he well-being o adolescen s. A indi-
idual le el, hese we e mos ly clinically ele an , anging
om 13 o 56% o adolescen s wi h no nega i e e ec in
any indica o . These esul s a e consis en wi h he esul s o
p e ious s udies on EI-YPA (Ibabe e al., 2018, 2021), bu
wo indica o s (emo ional ins abili y and li e sa is ac ion)
ob ained one yea e icacy. Mo eo e , as expec ed, physi-
cally and psychologically agg essi e discipline by a he s
and mo he s dec eased wi h a la ge e ec (d = 1.19), which
was clinically ele an o 64% (co po al punishmen ) and
51% (psychological agg ession) o pa en s, espec i ely.
Al hough in a p e ious e alua ion o EI-YPA (A noso e al.,
2021) a la ge e ec was ound, clinical ele ance was no
analyzed.
As expec ed, mo he s and a he s p esen ed a lowe le el
o clinical symp oms and highe empa hy, in line wi h p e-
ious e alua ion epo s o EI-YPA (A noso e al., 2021;
Ibabe e al., 2018). A g oup le el, he e ec sizes o pa en
Resul s a Indi idual Le el
Table 5 shows he e olu ion in clinical s a us be ween T1
(p e-in e en ion) and T3 ( ollow-up) o he adolescen s and
pa en s who made signi ican p og ess. Physical you h- o-
a he agg ession dec eased signi ican ly o 13% bu did
no change o 86%. Physical you h- o-mo he agg ession
dec eased signi ican ly o 17% bu did no change o 76%.
Howe e , mo e imp o emen s we e obse ed in psycholog-
ical you h- o-mo he (52%) and you h- o- a he agg ession
(50%). The changes in dep essi e symp oma ology we e
signi ican o 56% o adolescen s and 49% o pa en s.
Clinically ele an changes in pa en s (n = 45) we e
obse ed. Speci ically, in 29 pa en s (64%), he e was a
signi ican dec ease in co po al punishmen , while in 15
pa en s (27%) he e we e no signi ican changes, and he e
was an inc ease in his ype o iolen beha io in 4 pa en s
(9%). In addi ion, psychological agg ession dec eased sig-
ni ican ly in 23 cases (51%), and emained unchanged in 22
cases (49%).
Discussion
The EI-YPA p og am is di ec ed a child en wi h an ele a ed
isk o de eloping adolescen agg ession owa d one pa -
en . The main pu pose o his s udy was o ob ain e idence
o long- e m e ec s o he EI-YPA p og am (Ibabe e al.,
2019) on he ou come a iables o adolescen s and pa en s.
The e alua ion o EI-YPA showed p omising esul s, bo h a
g oup and a case le el.
The hypo hesis ha YPA di ec ed a a he s and/o mo h-
e s would dec ease one yea a e s a ing he p og am was
con i med o psychological agg ession owa d pa en s
wi h a la ge e ec (d = 0.93). Howe e , physical agg ession
Table 5 E olu ion a indi idual le el in YPA, agg essi e discipline
and dep essi e symp oma ology acco ding o Reliable Change Index
Va iables Posi i e
e ec
No de elopmen Nega-
i e
e ec
Adolescen beha io
Physical YPA a he 2 (13%) 14 (86%) 0 (0%)
Physical YPA mo he 5 (17%) 22 (76%) 2 (7%)
Psychological YPA a he 8 (50%) 8 (50%) 0 (%)
Psychological YPA mo he 15 (52%) 13 (45%) 1 (3%)
Dep essi e
symp oma ologya
10 (56%) 8 (44%) 0 (0%)
Pa en beha io
Co po al punishmen 29 (64%) 12 (27%) 4 (9%)
Psychological agg ession 23 (51%) 22 (49%) 0 (0%)
Dep essi e symp oma ology 22 (49%) 20 (44%) 3 (7%)
No e: a: The measu e is based on child epo , while he es o a i-
ables a e based on pa en epo
1 3
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