Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) - Detailed Report

• Educate individuals/family about relevance of the Cognitive Behavioral Therapy (CBT) model and physical abuse.
• Establish agreement with family to refrain from using physical force and to discuss any incidents involving the use of force within the family.
• Review the child's exposure to emotional abuse in the family and provide education about the parameters of abusive experiences (causes, characteristics, and consequences) in order to help child and caregiver better understand the context in which they occurred.
• Identify and address cognitive contributors to abusive behavior in caregivers (i.e., misattributions, high expectations, etc.) and/or their consequences in children (i.e., views supportive of aggression, self-blame, etc.) that could maintain any physically abusive or aggressive behavior.
• Teach affect management skills.
• Teach parents behavioral strategies to reinforce and punish behavior as alternatives to physical discipline.
• Teach pro-social communication and problem-solving skills to the family and help them to establish them as everyday routines.

Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) is rated a "3 – Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. For more information on the rating of a “3 – Promising Research Evidence,” please see the Scientific Rating Scale.

Kolko, D. (1996a). Individual cognitive behavioral treatment and family therapy for physically abused children and their offending parents: A comparison of clinical outcomes. Child Maltreatment, 1(4), 322-342.

Type of Study: Randomized controlled trial
Number of participants: 47
Population:

Age Range: Mean age of 8.6 years
Race/Ethnicity: 47% African American, 47% Caucasian, 6% biracial
Status (e.g., foster care, CW): Families referred by CPS or other agency for physical abuse.

Location/Institution: Pennsylvania
Summary: (To include comparison groups, outcomes, measures, notable limitations) Families were randomly assigned to the Cognitive Behavioral Therapy (CBT) or Family Therapy (FT) conditions. There was also a non-random group who received routine community services (RCS). Parents and children completed the Conflict Tactics Scale (CTS) and the Weekly Report of Abuse Indicators (WRAI) to evaluate high risk parental behaviors, and parents completed the Child Abuse Potential Inventory. Symptoms and problems relating to abuse were assessed using a subset of items from the Sexual Abuse Fear Evaluation (SAFE), the Children’s Attributions and Perceptions Scale (CAPS), the Youth Self Report (YSR), the Children’s Depression Inventory (CDI) and Children’s Hostility Inventory. Research associates completed the Global Assessment Scale (GAS) for children. Parent dysfunction, adjustment and parenting attitudes were assessed with the Brief Symptom Inventory (BSI), the Beck Depression Inventory (BDI, a subset of the Child Rearing Interview (CRI), Parenting Scale (PS) and Parent Opinion Questionnaire (POQ). Finally, children and parents completed the Family Environment Scale (FES) and the Family Assessment Device (FAD) to assess family functioning. Assessments were taken pre and post treatment and at 3-month and 1-year follow-ups. Results showed improvement over RCS families for both the CBT and Family Therapy conditions in parent-to-child violence, child internalizing and externalizing problems and parental depression. More RCS families had a recurrence of abuse, although the difference was not significant. All three groups showed overall improvement over time.
Length of post-intervention follow-up: 1 year

Kolko, D. J. (1996b). Clinical monitoring of treatment course in child physical abuse: Psychometric characteristics and treatment comparisons. Child Abuse and Neglect, 20(1), 23-43.

Type of Study: Randomized controlled trial
Number of participants: 38 children and their families
Population:

Age Range: Average age 8.6 years
Race/Ethnicity: 50% Caucasian, 42% African American, 8% biracial
Status (e.g., foster care, CW): Referred by CPS, caseworker, other agency or self-referred.

Location/Institution: Pennsylvania.
Summary: (To include comparison groups, outcomes, measures, notable limitations) Note: The participants in this study are a subsample from the group used in Kolko, 1996a. Families were randomly assigned to receive either Cognitive Behavioral treatment (CBT) or Family Therapy (FT). At pre-treatment assessment children and parents completed the Conflict Tactics Scale (CTS) and the Family Environment Scale (FES). Parents completed the Child Abuse Potential Inventory (CAP), the Parenting Scale (PS) and the Beck Depression Inventory (BDI). Children and parents reported on potential abuse indicators, including anger, physical discipline, and injuries, prior to each treatment session. Researchers found a moderate to high degree of correspondence between child and parent reports. Levels of parental anger and physical discipline improved from early to late treatment, with CBT parents showing greater improvement. Limitations include small sample size and the use of self-report measures.
Length of post-intervention follow-up: None

Kolko, D. J. (2002). Child physical abuse. In J. E. B. Myers, L. Berliner, J. Briere, C. T. Hendrix, C. Jenny, & T. Reid (Eds.), APSAC handbook of child maltreatment (Second ed., pp. 21-54). Thousand Oaks, CA: Sage.

Kolko, D. J., & Swenson, C. C. (2002). Assessing and treating physically abused children and their families: A cognitive behavioral approach. Thousand Oaks, CA: Sage Publications.