Completed Projects

The Pregnant Moms’ Empowerment Program Studies

The lifetime prevalence of IPV victimization for women in the US is 35%, with the highest risk during pregnancy. IPV during pregnancy is not only associated with decrements in maternal functioning, but children born to IPV-exposed women are more likely to have poor birth outcomes and problems in early attachment and adjustment. Despite the serious threats IPV poses to both mother and infant, few effective interventions for this population exist. The dearth of programs for pregnant women has resulted in high risk at the earliest stages of infant development – a risk that is imminently preventable.

PMEP US: Pilot Trial. The objective of the proposed project was to meet the critical need for intervention programs for IPV exposed pregnant women and their infants by adapting an existing effective program – the Moms’ Empowerment Program – and conducting a preliminary investigation of its effectiveness. Our proposed adaptation aimed to meet both pregnant women’s specific developmental needs (e.g., improve birth outcomes, success with breastfeeding and early parenting) and address the common mental health problems associated with IPV (i.e., PTSD, depression) that may adversely affect early infant development. The adaptation and evaluation of this program was conducted in partnership with Dr. Kathryn Howell at University of Wisconsin - Madison and includes N=137 women and their children, approximately half of women received the PMEP and half of whom were in a no treatment control group. The pilot study at the South Bend Site is generously supported through a grant from Help for Children, Chicago. We completed 5 waves of data collection, and manuscripts of treatment effects are both published and in progress. These include:

Howell, K.H., Gilliam, H.C., Carney, J.R., Maloney, C.A., & Miller-Graff, L.E. (in press). Long-term effects of the Pregnant Moms’ Empowerment Program (PMEP) on intimate partner violence revictimization, maternal mental health, and child internalizing and externalizing problems. Journal of Consulting and Clinical Psychology.

Howell, K. H., Napier, T. R., Scheid, C. R., Braungart-Rieker, J., & Miller-Graff, L. E. (2024). Evaluating the effects of prenatal intervention on parenting in women exposed to intimate partner violence. Journal of Family Psychology, 38(1), 118.

Miller-Graff, L. E., Paulson, J. L., Hasselle, A. J., Cummings, E. M., & Howell, K. H. (2022). Examining the efficacy of prenatal intervention in reducing IPV revictimization and improving maternal mental health: A quasirandomized controlled trial of the Pregnant Moms’ Empowerment Program (PMEP). Journal of Consulting and Clinical Psychology, 90(11), 884.

PMEP Mexico. In collaboration with Dr. Cecilia Martinez-Torteya (Universidad de Monterrey, University of Michigan) and Dr. Kathryn Howell (University of Wisconsin - Madision) we implemented a culturally-adapted version of the PMEP in Monterrey Mexico with N=92 women. This research was generously supported by the Notre Dame International Mexico Faculty Research Grant, the Indiana Clinical and Translational Sciences Institute & the Eck Institute for Global Health. Representative publications from this project include:

Carney, J. R., Martinez-Torteya, C., Miller-Graff, L. E., Gilliam, H. C., & Howell, K. H. (2023). A thematic analysis of barriers to and facilitators of wellbeing and resource access for IPV-exposed, pregnant women in Mexico. Journal of Family Violence, 38(7), 1377-1389.

Martinez-Torteya, C., Miller-Graff, L. E., Carney, J. R., Esparza-Dávila, S. P., Acuapa-Juárez, J. C., & Howell, K. H. (2025). The pregnant moms’ empowerment program–Mexico enhances mental health for women exposed to intimate partner violence: a pilot randomized controlled trial. Archives of Women's Mental Health, 1-13.

PMEP US: Randomized Clinical Trial. Given promising results emerging from our PMEP US pilot trial, we recently completed a randomized clinical trial of N=230 women comparing the PMEP's effectiveness to a contact-equivalent social support group. This RCT, supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development is a multi-site study being conducted in partnership with the REACH Lab (Dr. Kathryn Howell) (R01HD098092, Miller-Graff & Howell).

With the support of a competitive revision supplement from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Miller-Graff & Howell, R01HD098092-S1) Notre Dame Institute for Social Concerns, the Mental Research Institute, we are also collected intensive longitudinal data on women's pandemic-related stressors and the pandemic-related impacts on mother-child relational quality.

These studies were completed in July 2025 and data cleaning and manuscript preparation are in progress.

Supporting families in Lima, Peru

The BRAVE Lab has had a long-standing partnership with Instituto de Pastoral de la Familia (INFAM) in San Juan de Lurigancho, Lima, Perú. Together, we have conducted an arc of related studies aimed at supporting the needs of families in children in the district of San Juan de Lurigancho.

ESFA (Encuesta sobre la situación de la familia). In collaboration with INFAM and Universidad Católica Sedes Sapientiae we conducted a representative household survey of families living in the Canto Grande neighborhood, with the goal of developing a better understanding of the needs of families in the neighborhood and informing INFAM’s strategic planning. This work was supported by the Ford Family Program for Human Development Studies and Solidarity and Holy Cross Family Ministries. Representative publications include:

Miller-Graff, L. E., Scheid, C. R., Guzmán, D. B., & Grein, K. (2020). Caregiver and family factors promoting child resilience in at-risk families living in Lima, Peru. Child Abuse & Neglect, 108, 104639.

Guzmán, D. B., Miller-Graff, L. E., & Scheid, C. R. (2022). Types of childhood exposure to violence and association with caregiver trauma in Peru. Journal of interpersonal violence, 37(1-2), NP1125-NP1146.

Programa Empoderamiento de Madres Embarazadas (PEME). Rooted in our needs assessment in ESFA, and demographic surveys highlighting the needs of pregnant women in Lima, we intended to implement an adapted version of PMEP for women in Lima. When in-person care was disrupted by the pandemic, we instead developed and delivered a brief clinician-supported prenatal health intervention for pregnant women Whatsapp. This intervention, delivered during the pandemic, aimed to evaluate the feasibility of telehealth supports as well as the potential value-added of trauma-focused content to general psychoeducational supports on perinatal health in pregnancy. This project was supported by the Ford Program in Human Development Studies and Solidarity and the Kellogg Institute for International Studies. Representative publications include:

Carney, J. R., Gallo, P. A., Espinoza, V., Yataco, L., & Miller-Graff, L. E. (2024). Supporting accessible care for pregnant women experiencing IPV in Peru: A thematic analysis of barriers to and facilitators of women’s help seeking. Journal of Family Violence, 39(4), 581-593.

Carney, J. R., eun Park, J., Maloney, C. A., Blacutt, M., Romero, L. Y., & Miller-Graff, L. E. (2025). Effects of Peruvian mothers’ experiences of violence, resilience, and posttraumatic stress on infant temperament: A longitudinal path model. Development and Psychopathology, 1-15.

Miller-Graff, L.E., *Carney, J., Padilla Cancino, E. & Yataco Romero, L. (under invited revision) Assessing potential added benefits of trauma-focused content of a low-intensity psychoeducational intervention for perinatal women: A propensity-score matched analysis of a nonrandomized trial. Global Mental Health.

Common Elements Treatment Approach (CETA): Pilot Trial. Recognizing the mental health needs of mothers, the prevalence of trauma, and its downstream implications for families, we identified the CETA program as a potential important support for mothers of young children. With generous support from the Mental Research Institute, Ford Program in Human Development Studies and Solidarity, and the Kellogg Institute for International Studies, we conducted a pilot trial with N=20 women living in San Juan de Lurigancho. Data collection for the post-treatment follow-up is complete and data cleaning and analysis is underway. We plan to collect a final follow-up with participating women in September 2025.

Culturally and contextually relevant supports for conflict-affected youth and families in the Middle East

Interventions for families exposed to violence in Palestine. In collaboration with Dr. Mark Cummings and local partner organizations in Palestine, we developed a family-oriented, community-based support for families exposed to sociopolitical violence in Palestine. This development and pilot study of this program were supported by both the Notre Dame Institute for Scholarship in the Liberal Arts and Notre Dame International. Representative publications from this work include:

Miller-Graff, L. E., & Cummings, E. M. (2017). The Israeli–Palestinian conflict: Effects on youth adjustment, available interventions, and future research directions. Developmental Review, 43, 1-47.

Miller-Graff, L. E., & Cummings, E. M. (2022). Supporting youth and families in Gaza: A randomized controlled trial of a family-based intervention program. International Journal of Environmental Research and Public Health, 19(14), 8337.

Adapting the PTSD Coach Online Program for Egyptian youth. In collaboration with Dr. Kate Ellis at the American University in Cairo, we worked on adapting and implementing a pilot trial of the PTSD Coach Online program for youth exposed to violence in the Egyptian Revolution. This work was supported by the American University in Cairo and the Notre Dame Institute for Scholarship in the Liberal Arts. Representative publications include:

Ellis, K., Hosny, N., & Miller-Graff, L. (2022). User experiences of a culturally adapted web-based intervention for posttraumatic stress disorder in Egypt: A qualitative study. Psychotherapy, 59(1), 13.

Miller‐Graff, L., Ellis, K., & Hosny, N. (2021). PTSD coach online–Arabic: A randomized controlled pilot trial to examine feasibility, acceptability, and preliminary effectiveness. Journal of Traumatic Stress, 34(1), 23-34.

Miller-Graff, L. E., Paulson, J., Hosny, N., & Ellis, K. (2024). Trauma, resilience, and distress in post-revolution Egypt. Psychological Trauma: Theory, Research, Practice, and Policy, 16(1), 49.