Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT)
About This Program
Target Population: Children ages 3-17 and their parents (or caregivers) in families where parents engage in a continuum of coercive parenting strategies and children may present with PTSD symptoms, depression, behavioral problems and other difficulties
For children/adolescents ages: 3 – 17
For parents/caregivers of children ages: 3 – 17
Program Overview
CPC-CBT: Empowering Families Who Are at Risk for Physical Abuse is a short-term (16-20 sessions), strength-based therapy program for children ages 3-17 and their parents (or caregivers) in families where parents engage in a continuum of coercive parenting strategies. These families can include those who have been substantiated for physical abuse, those who have had multiple unsubstantiated referrals, and those who fear they may lose control with their child. Children may present with PTSD symptoms, depression, externalizing behaviors and a host of difficulties that are targeted within CPC-CBT. The program is grounded in cognitive behavioral theory and incorporates elements (e.g., trauma narrative and processing, positive reinforcement, timeout, behavioral contracting) from CBT models for families who have experienced sexual abuse, physical abuse, and/or domestic violence, as well as elements from motivational, family systems, trauma, and developmental theories. CPC-CBT helps the child heal from the trauma of the physical abuse, empowers and motivates parents to modulate their emotions and use effective non-coercive parenting strategies, and strengthens parent-child relationships while helping families stop the cycle of violence.
Program Goals
The goals of Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT) are:
- Reduce children's posttraumatic stress disorder (PTSD) symptoms, depression, other internalizing symptoms, and behavior problems
- Improve parent's mood, parental coping skills, and parenting skills
- Increase parental empathy for children by enhancing insight into the impact their parenting behavior and interactions have on their children emotionally and behaviorally
- Increase positive parenting skills
- Enhance parent-child relationships
- Reduce current and future use of corporal punishment by parents
Logic Model
The program representative did not provide information about a Logic Model for Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT).
Essential Components
The essential components of Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT) are:
- Phase 1: Engagement & Psychoeducation - Engaging and motivating parents who are often not contemplating changing their parenting style or interactions with their children by using the following techniques:
- Engagement strategies
- Motivational Interviewing/consequence review
- Individualized goal setting
- Providing violence psychoeducation including educating both parents and children on:
- Different types of violence
- The continuum of coercive behavior
- The impact of violent behavior on children
- Providing psychoeducation for parents about:
- Child development
- Realistic expectations for children's behavior
- Addressing parental history of trauma exposure including its impact on:
- Their relationships with their parents
- Their parenting approach with their own children
- Phase 2: Effective Coping Skill Building - Empowering parents to be effective by working collaboratively with them to:
- Develop adaptive coping skills
- Cognitive coping
- Anger management
- Relaxation
- Assertiveness
- Self-care
- Problem solving
- Assist them in remaining calm while interacting with their children
- Develop nonviolent conflict resolution skills
- Develop a variety of problem-solving skills related to child rearing
- Develop a variety of non-coercive child behavior management skills.
- Learn the dynamics of their interactions with their children and what escalates anger and violence during these interactions and how to use skills to diffuse the situation.
- Phase 3: Family Safety - Developing a family safety plan that involves:
- Learning how to identify when parent-child interactions are escalating
- Taking a cool down period in order to enhance safety and communication in the family
- Having parents and children rehearse the implementation of the family safety plan
- Introducing other safety components across the therapy
- Phase 4: Abuse Clarification
- Clarification involves parent writing an abuse clarification letter and child developing a trauma narrative about the abuse experienced
- Specifically, clinician encourages child to write about or share their abusive experiences while focusing on their thoughts and feelings associated with the abuse
- While child is developing this trauma narrative, clinician also assists parents in processing their own thoughts and feelings while writing and revising a "clarification" letter to their children to enhance their empathy for their children and to demonstrate that they take full responsibility for their abusive behavior
- The clarification letter also serves to:
- Alleviate the child of blame
- Respond to the child's questions and/or worries
- Correct the child's cognitive distortions concerning the abuse
- The parents and children share the clarification letter and trauma narrative in joint segments, unless this process is contraindicated. However, in most cases, this process enhances the parent's empathy for the child and is a powerful therapeutic tool for strengthening the parent-child relationship. CPC-CBT is the only treatment involving at-risk parents that incorporates the trauma narrative into the clarification process.
- Parenting Skills Training - Parenting skills training is provided across all phases:
- Therapists help families develop effective communication skills to increase family members' feelings of validation and cooperation with one another
- Over the course of treatment, joint parent-child sessions involve having parents practice implementation of active listening, communication skills, and positive parenting first with the therapist and then with children while the clinicians coach them by offering positive reinforcement and corrective feedback to enhance the skills
- CPC-CBT can be delivered in individual family sessions or group family sessions. In the group sessions, it is recommended to have 4-5 families involved and that may include multiple caregivers and multiple children.
Program Delivery
Child/Adolescent Services
Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT) directly provides services to children/adolescents and addresses the following:
- Children's PTSD, depression, self-esteem, social skills, empathy skills, problem solving and behavioral problems, such as aggression and other acting out behaviors
Parent/Caregiver Services
Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT) directly provides services to parents/caregivers and addresses the following:
- Parental lack of motivation and engagement, depression, anger, self-control, assertiveness, attributions about children's behavior, empathy for children, positive parenting skills, family relationships, parent-child interactions, and parental trauma history.
Services Involve Family/Support Structures:
This program involves the family or other support systems in the individual's treatment: All caregivers, including grandparents, and all siblings are encouraged to participate
Recommended Intensity:
Individual: 90-minute sessions weekly; Group: 120-minute session weekly
Recommended Duration:
16-20 sessions
Delivery Settings
This program is typically conducted in a(n):
- Birth Family Home
- Outpatient Clinic
- Community-based Agency / Organization / Provider
Homework
Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT) includes a homework component:
Parents are assigned weekly individualized homework assignments to use coping skills and parenting skills to help facilitate the acquisition of and generalization of skills to the home. Parents are also assisted in developing individualized behavioral management plans for their children, which they implement as homework. Children are assigned homework to use coping skills on an as-needed basis.
Languages
Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT) has materials available in languages other than English:
Czech, Finnish, Japanese, Spanish, Swedish
For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).
Resources Needed to Run Program
The typical resources for implementing the program are:
- Trained clinicians
- Office space large enough for family or group of families
- Therapeutic books, games, and art supplies are recommended to teach parents and children skills
Manuals and Training
Prerequisite/Minimum Provider Qualifications
Clinicians who implement CPC-CBT should have a Master's degree or higher in one of the mental health professions or be working towards one of these degrees under the supervision of a licensed mental health professional. Given that CPC-CBT is based on cognitive-behavioral principles, it is helpful but not necessary for clinicians to be well grounded in Cognitive-Behavioral Therapy. It is important for clinicians to prepare themselves to work in a supportive, nonjudgmental manner with parents who have harmed their children in some way.
Manual Information
There is a manual that describes how to deliver this program.
Program Manual(s)
Manual Information:
- Runyon, M. K., & Deblinger, E. (2014). Combined Parent-Child Cognitive Behavioral Therapy (CPC-CBT): An approach to empower families at-risk for child physical abuse. Oxford University Press.
The English version is available from Oxford University Press. The translations of published manual are available in Swedish, Finnish, Czech, and Japanese.
Training Information
There is training available for this program.
Training Contact:
- Melissa K. Runyon, PhD
Melissarunyonphd@gmail.com
phone: (609) 247-5273
Training Type/Location:
Varies; training programs can be provided on-site, regionally or nationally
Number of days/hours:
Varies depending on training program requested. CPC-CBT's developers are utilizing National Center for Child Traumatic Stress (NCCTS) Learning Collaborative (LC) methodology to enhance the adoption and implementation of CPC-CBT. These are intended to help agencies gain the necessary clinical and implementation competence to incorporate and sustain CPC-CBT as a part of their current practices.
There are three CPC-CBT training options available to organizations. The first two training options listed incorporate LC methodology. The first is more intensive than the second.
The first training option involves a formal Learning Collaborative (LC). An LC consists of pre-work, three 2-day learning sessions spaced over the course of 8 to 12 months with consultation calls in the implementation of CPC-CBT occurring twice per month between the learning sessions.
Agencies may opt for the second training option that incorporates some of the LC methodology, but is relatively less intensive. This involves two full days of in-person training on the model which includes role-plays and performance feedback. Because the program is highly structured, ongoing consultation that occurs twice per month for at least one full cycle of therapy is recommended for clinicians as well. Feedback on audiotaped client sessions is highly recommended. Two days of advanced training is also available after the initial training sessions to address advanced concepts and questions that arise after clinicians have implemented the model with multiple clients.
For agencies that are unsure if they are able to commit to the above requirements or who need additional information about CPC-CBT to determine if it is feasible to implement the model, a third CPC-CBT training option is available. This option involves two days of introductory training in the model which includes role-plays and performance feedback. However, agencies should not expect staff to be able to fully implement CPC-CBT after a single training event.
Implementation Information
Pre-Implementation Materials
There are pre-implementation materials to measure organizational or provider readiness for Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT) as listed below:
There is a readiness assessment and pretraining questionnaire is available from Melissa Runyon, PhD (see contact information at the bottom of the page).
Formal Support for Implementation
There is formal support available for implementation of Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT) as listed below:
There are multiple training packages available, ranging from a 2-day in-person/4-day virtual didactic training to an intensive yearlong Learning Collaborative Training package. To assist organizations in implementing CPC-CBT with fidelity, the Learning Collaborative is a 12-month training experience that involves three 2-day in-person/virtual training sessions and consultation.
Consultation regarding implementation of CPC-CBT is available for Senior Leaders, Supervisors and Therapists. This can be offered via teleconference and site visits.
Fidelity Measures
There are fidelity measures for Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT) as listed below:
The CPC-CBT Adherence Checklist is available as part of the appendix in the CPC-CBT treatment manual. The checklist lists the components/skills associated with each phase of CPC-CBT for parent sessions, child sessions, and joint parent-child sessions. The checklist can be utilized to rate the presence or absence of these skills/components during each phase of CPC-CBT either while observing a live session or digital recording.
The CPC-CBT Adherence Checklist is available from Melissa Runyon, PhD (see contact information at the bottom of the page).
Fidelity Measure Requirements:
Fidelity measures are required to be used as part of program implementation.
Implementation Guides or Manuals
There are implementation guides or manuals for Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT) as listed below:
There are implementation manuals for senior leaders and administrators available from Melissa Runyon, PhD (see contact information at the bottom of the page).
Implementation Cost
There are no studies of the costs of Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT).
Research on How to Implement the Program
Research has been conducted on how to implement Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT) as listed below:
Thulin, J., Kjellgren, C., & Nilsson, D. (2018). Children's experiences with an intervention aimed to prevent further physical abuse. Child & Family Social Work, 24(1), 17–24. https://doi.org/10.1111/cfs.12476
Relevant Published, Peer-Reviewed Research
Child Welfare Outcomes: Safety and Child/Family Well-Being
Runyon, M. K., Deblinger, E., & Schroeder, C. M. (2009). Pilot evaluation of outcomes of Combined Parent-Child Cognitive-Behavioral Group Therapy for families at-risk for child physical abuse. Cognitive and Behavioral Practice, 16(1), 101–118. https://doi.org/10.1016/j.cbpra.2008.09.006
Type of Study:
One-group pretest–posttest study
Number of Participants:
33
Population:
- Age — Caregivers: 25–54 years; Children: 4–14 years
- Race/Ethnicity — Caregivers: 50% African-American, 33% Hispanic, and 17% Caucasian; Children: 52% African-American, 19% Hispanic, 19% Caucasian, and 10% Biracial
- Gender — Caregivers: Not specified; Children: 13 Female and 8 Male
- Status — Participants were abusive parents and their children who were referred for services to a university medical school–based program specializing in the assessment and treatment of children who experienced or were at risk for child physical abuse.
Location/Institution: New Jersey
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT), a treatment model that addresses the complex needs of the parent who engages in physically abusive behavior and the traumatized child. Measures utilized include the Beck Depression Inventory–II, the Child Behavior Checklist for Ages 6-18 (CBCL 6/18) or the Child Behavior Checklist for Ages 1.5 - 5 (CBCL 1.5/5), the Parental Anger Inventory (PAI), the Kiddie-Sads Posttraumatic Stress Disorder Interview (K-SADS PTSD), the Parent-Child Conflict Tactics Scale, and the Alabama Parenting Questionnaire–Self Report. Results indicate that both parents and children reported significant pretreatment to posttreatment reductions in the use of physical punishment. Results also demonstrated pretreatment to posttreatment improvements in parental anger toward their children, and consistent parenting, as well as children's posttraumatic stress symptoms and behavioral problems. Limitations include lack of randomization of participants, small sample size, and lack of follow-up.
Length of controlled postintervention follow-up: None.
Runyon, M. K., Deblinger, E., & Steer, R. A. (2010). Group cognitive behavioral treatment for parents and children at-risk for physical abuse: An initial study. Child & Family Behavior Therapy, 32(3), 196–218. https://doi.org/10.1080/07317107.2010.500515
Type of Study:
Randomized controlled trial
Number of Participants:
104; 34 completed the follow-up assessment
Population:
- Age — Caregivers: 25–51 years; Children: 7–13 years
- Race/Ethnicity — Intervention: Caregivers 100% African-American; Children 53% African-American; Control: Caregivers 70% African-American; Children 27% African-American
- Gender — Intervention: Caregivers 46% Female; Children 44% Female; Control: Caregivers 35% Female; Children 50% Female
- Status — Participants were abusive parents and their children who were referred to a medical school-based child abuse clinic from the local child protection services agencies, prosecutors' offices, and health fair.
Location/Institution: New Jersey
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare the efficacy of two types of group cognitive behavioral therapy, Combined Parent-Child Cognitive Behavioral Therapy (CPC-CBT) and Parent-Only Cognitive-Behavioral Therapy (CBT), for treating the traumatized child and at-risk or offending parent in cases of child physical abuse. Participants were randomly assigned to CPC-CBT or parent-only CBT. Measures utilized include Conflict Tactics Scale-Parent-Child (CTS-PC), the Kiddie-Sads-Present and Lifetime Version (K-SADS-PL), Alabama Parenting Questionnaire (APQ-P & APQ-C), and the Child Behavior Checklist (CBCL). Results indicate that the children and parents in the CPC-CBT group demonstrated greater improvements in total posttraumatic symptoms and positive parenting skills respectively, compared to those who participated in the Parent-Only CBT group. Limitations include small sample size, lack of complete follow-up data, and length of follow-up.
Length of controlled postintervention follow-up: 3 months.
Kjellgren, C., Svedin, C. G., & Nilsson, D. (2013). Child physical abuse—experiences of combined treatment for children and their parents: A pilot study. Child Care in Practice, 19(3), 275–290. https://doi.org/10.1080/13575279.2013.785934
Type of Study:
One-group pretest–posttest study
Number of Participants:
51
Population:
- Age — Children: 6–14 years
- Race/Ethnicity — Not specified
- Gender — Caregivers: Not specified, Children: 15 Males and 10 Females
- Status — Participants were abusive parents and their children.
Location/Institution: Sweden (Kristianstad, Linkoping, Lund and Malmo)
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to report on Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT) for families at risk for child abuse. Measures utilized were Children’s Depression Inventory (CDI), the Trauma Symptom Checklist for Children (TSCC), the Children and Parenting Strategies, Beck Depression Inventory II (BDBI – II), the Child Behavior Checklist (CBCL), the Kiddie-Sads Posttraumatic Stress Disorder Interview (K-SADS PTSD), and the Alabama Parenting Questionnaire – Self Report (APQ). Results indicate that parents and children reported significant pretreatment to posttreatment reductions in the use of physical punishment, as well as significantly decreased symptoms of depression among parents, less use of violent parenting strategies and decreased inconsistent parenting. Children initially reported high levels of traumatic experiences and symptoms of posttraumatic stress disorder (PTSD). After treatment, the trauma symptoms and depression among children was significantly reduced. Children also reported that parents used significantly less violence and increased positive parenting strategies after completion of the treatment. Limitations include small sample size, lack of a control group and randomization, and lack of follow-up.
Length of controlled postintervention follow-up: None.
Thulin, J., Nilsson, D., Svedin, C. G., & Kjellgren, C. (2020). Outcomes of CPC-CBT in Sweden concerning psychosocial well-being and parenting practice: Children's perspectives. Research on Social Work Practice, 30(1), 65–73. https://doi.org/10.1177/1049731519843352
Type of Study:
Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants:
62
Population:
- Age — Not specified
- Race/Ethnicity — Not specified
- Gender — 52% Female and 48% Male
- Status — Participants were families who were involved in the child welfare system.
Location/Institution: Sweden
Summary:
(To include basic study design, measures, results, and notable limitations)
The purpose of the study was to explore the outcome of the intervention Combined Parent Child–Cognitive Behavioral Therapy (CPC-CBT) for physically abused children. Measures utilized include the Alabama Parenting Questionnaire-C (APQ-C), the Trauma Symptom Checklist for Children (TSCC), and administrative child abuse data. Results indicate that children reported a significant decrease in parental use of corporal punishment after treatment and a significant reduction in symptoms associated with trauma (decreased to normal values for TSCC). The positive changes remained at the 6-month follow-up. Limitations include nonrandomization of participants, high attrition rate, lack of treatment-as-usual control group, and length of follow-up.
Length of controlled postintervention follow-up: 6 months.
Additional References
Runyon, M. K., Cruthirds, S., & Deblinger, E. (2017). Evidence-based approaches to empower children and families at risk for child physical abuse to overcome abuse and violence. In L. Dixon, D. F. Perkins, C. Hamilton-Giachritsis, & L. A. Craig (Eds.), The Wiley handbook of what works in child maltreatment: An evidence-based approach to assessment and intervention in child protection (pp. 295-312). https://doi.org/10.1002/9781118976111.ch18
Runyon, M. K., & Deblinger, E. (2014). Combined Parent-Child Cognitive Behavioral Therapy (CPC-CBT): An approach to empower Families at-risk for child physical abuse (Programs that work). Oxford University Press.
Santa, E. J., & Runyon, M. K. (2015). Addressing ethnocultural factors in treatment for child physical abuse. Journal of Child and Family Studies, 24(6), 1660–1671. https://doi.org/10.1007/s10826-014-9969-5
Contact Information
- Melissa K. Runyon, PhD
- Agency/Affiliation: Training and Consulting Services
- Website: melissarunyon.com/cpc-cbt
- Email: melissarunyonphd@gmail.com
- Phone: (609) 247-5273
Date Research Evidence Last Reviewed by CEBC: September 2022
Date Program Content Last Reviewed by Program Staff: January 2019
Date Program Originally Loaded onto CEBC: October 2012
