The information in this program outline is provided by the program representative and edited by the CEBC staff. The Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) program has been rated by the CEBC in the area of: Trauma Treatment (Child & Adolescent).

• Types of Maltreatment: Physical Abuse, Emotional Abuse
• Target Population: Caregivers who are aggressive and physically, emotionally, or verbally abuse their children and their children who experience behavioral dysfunction, especially aggression, as a result of the abuse, as well as high conflict families who are at-risk for physical abuse/aggression.

AF-CBT (originally named Abuse-Focused Cognitive-Behavioral Therapy) is a treatment based on principles derived from learning and behavioral theory, family systems, cognitive therapy, developmental victimology, and the psychology of aggression. It integrates specific techniques to target school-aged abused children, their caregivers, and the larger family system. Through training in specific intrapersonal and interpersonal skills, AF-CBT seeks to promote the expression of appropriate/pro-social behavior and discourage the use of aggressive or hostile behavior.

AF-CBT addresses both the key risks for and clinical consequences of exposure to family aggression, conflict, and coercion. The key risks include coercive parenting practices, anger hyperarousal, negative child attributions, and family conflict. The clinical consequences include child aggression, poor interpersonal skills/functioning, and emotional reactivity. In general, it attempts to address both clinical (well-being) and safety concerns by integrating training in general psychological skills and, if relevant, treatment focusing upon a specific aggressive, abusive, or traumatic experience.

AF-CBT has primarily been used with children and adolescents (ages 5-16). Treatment is not specifically designed for any one ethnic/racial group. It has been used extensively with urban African-American families, but has more recently been applied with Latino, South Asian, and Caribbean-American families. Most of the cases come from urban, inner-city, and low-income families (e.g., Pittsburgh, New York City, Baltimore, Toronto, Seattle, San Francisco, Los Angeles), but there are more recent applications in rural areas across several states (e.g., Michigan, New Hampshire, Oregon). Common sources of referral include child welfare/child protective services caseworkers, mental health agencies, child advocacy centers, family support centers, and self-referral.

The goals of AF-CBT are to:

• Reduce conflict and increase cohesion in family.
• Reduce use of coercion (hostility, anger, verbal aggression, threats) by caregiver and, as relevant, other family members.
• Reduce use of physical force (aggressive behavior) by caregiver and, as relevant, other family members.
• Reduce child physical abuse risk or recidivism (prevention of child welfare system involvement or repeated reports/allegations).
• Improve level of child’s safety/welfare and, as relevant, family functioning.