Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
High
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT) has been rated by the CEBC in the areas of: Prevention of Child Abuse and Neglect (Secondary) Programs, Parent Training Programs that Address Child Abuse and Neglect, Interventions for Abusive Behavior and Trauma Treatment - Client-Level Interventions (Child & Adolescent).

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

Brief Description

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

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.

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

Delivery Settings

This program is typically conducted in a(n):

  • Birth Family Home
  • Community Agency
  • Outpatient Clinic

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:

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

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.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

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). A 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

Since Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

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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:

A readiness package is provided to interested agencies. Administrators and clinicians are also asked to complete readiness survey through Survey Monkey.

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 two-day didactic training to an intensive Learning Collaborative Training package. To assist organizations with implementation of CPC-CBT with fidelity, the Learning Collaborative is a 12-month training experience that involves three 2-day in-person training sessions and consultation.

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.

Implementation Guides or Manuals

There are implementation guides or manuals for Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT) as listed below:

Runyon & Deblinger developed a separate CPC- CBT Implementation manual; however, much of the material in this manual has since been incorporated into the published treatment manual. Either manual can be obtained by contacting the program representative listed at the end of this entry.

Research on How to Implement the Program

Research has not been conducted on how to implement Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT).

Relevant Published, Peer-Reviewed Research

This program 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 study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcomes: Safety and Child/Family Well-Being

Show relevant research...

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, 101-118.

Type of Study: One group pretest-posttest
Number of Participants: 33

Population:

  • Age — Caregivers: 25-54 years, Children: 4-14 years
  • Race/Ethnicity — Caregivers: 50% African-American, 33% Hispanic, and 16.7% Caucasian; Children: 52.4% African-American, 19% Hispanic, 19% Caucasian, and 9.5% Biracial
  • Gender — Caregivers: Not specified, Children: 13 Females and 8 Males
  • 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 comparison groups, outcomes, measures, notable limitations)
This paper examined 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. This study was conducted to examine the feasibility of a Cognitive-Behavioral Therapy group approach that incorporates the child into the offending parent's treatment. Measures included 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. 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 postintervention follow-up: None.

Runyon, M. K., Deblinger, E., & Steer, R. (2010). Group cognitive behavioral treatment for parents and children at-risk for physical abuse: An initial study. Child & Family Behavior Therapy, 32, 196-218.

Type of Study: Randomized controlled trial
Number of Participants: 104; only 34 completed the follow-up assessment

Population:

  • Age — Caregivers: 25-51 years, Children: 7-13 years
  • Race/Ethnicity — Parents: Intervention - 100% African-American, Control - 70% African-American; Children: Intervention - 53% African-American, Control - 27% African-American
  • Gender — Caregivers: Intervention - 46% Female, Control - 35% Female, Children: Intervention - 44% Female, Control - 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 comparison groups, outcomes, measures, notable limitations)
This study compared 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. Parents and children were randomly assigned to CPC-CBT or parent-only CBT. Measures utilized were 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 show 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. This study is limited due to the small sample size and high attrition rate. Limitations include small sample size, high attrition rate, and length of follow-up.

Length of 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.

Type of Study: One group pretest-posttest
Number of Participants: 51

Population:

  • Age — Caregivers: Not specified, 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 comparison groups, outcomes, measures, notable limitations)
This study reports on Combined Parent-Child Cognitive-Behavioral Therapy (CPC-CBT) for families at risk for child abuse. Four teams (within child protection and child and adolescent psychiatry services, in Sweden) were trained to run the treatment for families where child physical abuse has occurred. 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). 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 postintervention follow-up: None.

References

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). New York, NY: Oxford University Press.

Runyon, M. K., Ryan, E., Kolar, R., & Deblinger, E. (2004). An overview of child physical abuse: Developing an integrated parent-child cognitive-behavioral treatment approach. Trauma, Violence, & Abuse: A Review Journal, 5, 65-85.

Runyon, M.K., & Urquiza, A. (2011). Child physical abuse: Interventions for parents who engage in coercive parenting practices and their Children. In J. E. B. Myers (Ed.), The APSAC handbook on child maltreatment (pp. 195-212). Los Angeles, CA: Sage Publications.

Contact Information

Name: Melissa K. Runyon, PhD
Email:
Phone: (404) 469-8668
Name: Esther Deblinger, PhD
Agency/Affiliation: CARES Institute
Department: Rowan School of Osteopathic Medicine
Website: www.caresinstitute.org/services_parent-child.php
Email:
Phone: (856) 566-7036
Fax: (856) 566-2778

Date Research Evidence Last Reviewed by CEBC: June 2017

Date Program Content Last Reviewed by Program Staff: February 2015

Date Program Originally Loaded onto CEBC: October 2012