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

About This Program

Target Population: Caregiver and their child between the ages 5 and 17 years whose family struggles with conflict and/or coercion due to parent, child, and/or overall family behavior

For children/adolescents ages: 5 – 17

For parents/caregivers of children ages: 5 – 17

Program Overview

Alternatives for Families: A Cognitive Behavioral Therapy (AF–CBT) is designed to be a comprehensive approach for reducing or preventing the effects of exposure to child or family anger, aggression, and/or child physical abuse. Accordingly, it seeks to reduce many of the known risks for physical abuse/violence while also helping families to recover from the effects of exposure to these conditions. AF–CBT (originally named Abuse-Focused Cognitive-Behavioral Therapy) teaches parents and children intrapersonal and interpersonal skills to enhance self-control, promote positive family relations, and reduce violent behavior. These skills include anger and anxiety management, how to challenge misattributions to support flexible thinking, child social skills, effective and safe discipline strategies, and healthy family communication and problem-solving skills. These skills seek to improve self-control, help families get along better, and maintain a safe and secure home environment. AF–CBT seeks to improve the relationships between children and their parents/caregivers who experience any of the following clinical concerns:

  • Family conflict/arguments
  • Anger and verbal aggression, including emotional abuse
  • Child behavior problems, including physical aggression
  • Threats or use of harsh/punitive/ineffective physical discipline or punishment
  • Child physical abuse

AF–CBT is a treatment based on principles derived from learning and behavioral theory, family systems, cognitive therapy, developmental victimology, and the psychology of aggression.

Program Goals

The goals of Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) are to:

  • Strengthen relationships and functioning between the caregiver and child and/or within family.
  • Increase safe use of positive parenting and discipline practices.
  • Enhance behavior and well-being.
  • Increase ability to manage emotions and be flexible in thinking.
  • Learn which conditions help maintain safety and use them in home.
  • Increase ability to manage conflictual or coercive interactions (e.g., anger, verbal aggression, threats of force, emotional abuse).
  • Reduce the use of physical force (i.e., aggressive behavior).
  • Lower physical abuse risk or recidivism (i.e., prevent child welfare system involvement or repeated reports/allegations).
  • Reduce posttraumatic stress symptoms, especially in children.

Essential Components

The essential components of Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) include:

  • Eligibility Criteria - The following general criteria have been developed to facilitate the identification of individuals or families who may benefit from this intervention:
    • Fully Required Characteristics (all of the following must be valid to benefit from AF-CBT):
      • At least one child aged 5-17 years
      • A caregiver (biological, foster, adoptive, or kinship) who will participate in services
      • Caregiver and child have adequate capacity/repertoire to learn/benefit from AF-CBT
    • One of the following must be valid to benefit from AF-CBT:
      • A family who has conflicts and/or heated arguments
      • A caregiver who has a history of anger/hostility, uses physical force/discipline/coercion, or an allegation/history of child physical abuse
      • A child (age 5-17 years) has a history of anger, behavior problems (e.g., defiance, aggression, explosiveness), trauma symptoms/posttraumatic stress disorder (PTSD) after physical discipline/abuse, or prior exposure to harsh discipline/physical abuse
  • Recommended Assessments for Use in AF-CBT:
    • Four brief assessment instruments are currently suggested for use in AF-CBT, each of which examines a few key clinical targets. These tools include:
      • The Alabama Parenting Questionnaire – Short Form (APQ-SF)
      • The Brief Child Abuse Potential Inventory (B-CAP)
      • The Child PTSD Symptom Scale (CPSS)
      • The Strengths and Difficulties Questionnaire (SDQ)
    • These measures can be completed independently (hard copy, electronically/online) or via interview.
    • Background information, scoring and interpretation guidelines for each instrument, a copy of the item content of each instrument in both English and Spanish.
    • Information on how to obtain the tools is provided to practitioners who receive a formal training in AF-CBT and can be accessed via the website.
  • AF-CBT Treatment Overview:
    • AF-CBT integrates specific techniques to target school-aged abused children, their caregivers, and the family system. Through training in specific intrapersonal and interpersonal skills, AF-CBT seeks to promote self-control/interpersonal effectiveness and discourage the use of coercive or aggressive behavior.
    • Consistent with cognitive-behavioral therapy (CBT) approaches, AF-CBT includes techniques that target three related domains in which people respond to different circumstances: cognition (thinking), affect (feelings and physiological reactivity), and behavior (doing). AF-CBT includes training in various psychological skills in each of these response channels.
    • The descriptions of these techniques, relevant handouts, training examples, and outcome measures are integrated in a structured approach (comprehensive session guide) that practitioners and supervisors can easily access and use.
    • AF-CBT is designed to be primarily used with children and adolescents (ages 5-17) and their caregivers. The treatment can be delivered to families representing diverse racial and ethnic groups. The program also can be used frequently with underserved, multiproblem, and low-resource families in a broad range of urban, suburban, and rural settings in the U.S. and other countries.
    • Common sources of referral include child welfare, child protective services caseworkers, mental health agencies, child advocacy centers, family support centers, juvenile justice programs, and self-referral.
  • Fundamental Skills included in AF-CBT:
    • The program has incorporated strategies to address several common clinical or therapeutic issues that may arise during intervention and often require some type of planned professional response.
    • The practitioner is offered some guidelines at the beginning of the AF-CBT Session Guide to address the following:
      • Assessment and functional analysis
      • “CA$H”: Check-in on Attendance/Agenda-setting, Safety, and Home Practice
      • Alternatives for Families Plan (AFP)
      • Safety planning and other potential crises
      • Addressing inconsistent attendance
      • Managing escalation in session
      • Enhancing motivation
  • AF-CBT Treatment Tasks:
    • Discuss any incidents involving conflict, hostility, and the use of force that increase a family’s risk of threats to personal safety or welfare.
    • Educate individuals/family about relevance of the CBT model and impact of exposure to verbal and physical coercion to help child and caregiver better understand the context in which they occurred.
    • Identify and address cognitive contributors to abusive behavior in caregivers (e.g., misattributions, high expectations) and/or their consequences in children (e.g., views supportive of aggression, self-blame) that could maintain any physically abusive or aggressive behavior.
    • Teach affect (anger, anxiety) management skills to enhance self-control and reduce escalation/outbursts.
    • Train parents to use behavioral strategies to reinforce and punish behavior as alternatives to physical discipline.
    • With the child, process thoughts and feelings related to the abuse experience.
    • As relevant, help the caregiver and child to overcome the emotional and cognitive complications that often ensue following an incident of explosive anger, aggression, or abuse.
    • Identify and practice healthy communication and effective problem-solving skills to help the family establish them as everyday routines.
  • AF-CBT Treatment Phases: AF-CBT is delivered across three treatment phases, as listed below. In general, the content of first and second phases is administered in individual sessions to caregivers and children/adolescents, whereas the content of the third phase is administered in joint caregiver-child sessions. Caregivers may be seen occasionally for a brief “check-in” after a child session. The suggested sequence for conducting the treatment proceeds from teaching intrapersonal skills first (e.g., affective, cognitive), followed by interpersonal skills (e.g., behavioral, social). Of course, the topics/sessions can be flexibly delivered (adapted, abbreviated, or repeated) based on the family’s progress and treatment needs. The primary content in each topic is organized into three phases and is reflected in the acronym, A-L-T-E-R-N-A-T-I-V-E-S.
    • PHASE I: Engagement and Psychoeducation
      • Topic 1: Orientation–Caregiver and Child
      • Topic 2: Alliance Building and Engagement–Caregiver
      • Topic 3: Learning about Feelings and Family Experiences–Child
      • Topic 4: Talking about Family Experiences and Psychoeducation–Caregiver
    • PHASE II: Individual Skill-Building (Skills Training)
      • Topic 5: Emotion Regulation–Caregiver
      • Topic 6: Emotion Regulation–Child
      • Topic 7: Restructuring Thoughts–Caregiver
      • Topic 8: Restructuring Thoughts–Child
      • Topic 9: Noticing Positive Behavior–Caregiver
      • Topic 10: Assertiveness and Social Skills–Child
      • Topic 11: Techniques for Managing Behavior–Caregiver
      • Optional Topic 12: Imaginal Exposure–Child
      • Topic 13: Preparation for Clarification–Caregiver
    • PHASE III: Family Applications
      • Topic 14: Verbalizing Healthy Communication–Caregiver and Child
      • Topic 15: Enhancing Safety through Clarification–Caregiver and Child
      • Topic 16: Solving Family Problems–Caregiver and Child
      • Topic 17: Graduation–Caregiver and Child

Program Delivery

Child/Adolescent Services

Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) directly provides services to children/adolescents and addresses the following:

  • Exposure to family conflict/aggression or a specific abusive experience, emotional and cognitive effects of such exposure (e.g., anger/anxiety, misattributions, trauma-related symptoms), aggression/behavioral dysfunction, poor social/interpersonal skills, poor communication and problem solving, and need for safety planning

Parent/Caregiver Services

Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) directly provides services to parents/caregivers and addresses the following:

  • Limited motivation for or ambivalence about treatment, heightened personal stress and exposure to adverse family experiences, poor anger/anxiety management, attributional biases, limited effectiveness of child management and challenging child behavior, poor communication and problem solving, and need for clarification meeting to address a prior incident of abuse or conflict

Recommended Intensity:

One- or two-hour-long sessions per week; sessions can be longer or additional sessions can be scheduled per week, as needed, especially when the required treatment duration is limited to a few months due to fiscal or programmatic regulations. Longer sessions can be conducted to address multiple family problems/crises.

Recommended Duration:

There is no typical outpatient course of treatment, given the variability seen across referred families in problem severity, caregiver functioning, family resources, and treatment compliance/progress. Cases can be expected to receive between 20 and 24 hours of direct service (or longer), generally spanning 6-9 months.

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Foster / Kinship Care
  • Hospital
  • Outpatient Clinic
  • Group or Residential Care
  • School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) includes a homework component:

Children and caregivers are requested to complete tailored home practice assignments designed to facilitate skills acquisition and to provide feedback regarding the utility of specific treatment methods.

Languages

Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) has materials available in languages other than English:

Hebrew, Japanese, Korean, Spanish

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:

A confidential space, assessment, treatment, and documentation materials, and optional digital audio or video-taping equipment to facilitate case supervision

Education and Training

Prerequisite/Minimum Provider Qualifications

Mental health practitioners with:

  • Master’s degree or higher
  • Clinician has professional license to practice, is license eligible, or works under/with licensed supervisor.

Education and Training Resources

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

There is an AF-CBT Session Guide that is only available to those enrolled in a training group. The full citation for the guide was not provided by the program representative.

Training Contacts:
Training is obtained:

AF-CBT training generally follows a Learning Community model that involves the delivery of a sequence of planned activities across interrelated phases to a specific cohort of practitioners. Lasting a year, the full training program can be conducted with the staff of a local or individual agency, or with practitioners from multiple agencies who join a regional or national training program or training institute. Whenever possible, preparation and training activities tailored to different roles or levels within a given agency or program (e.g., administrators, supervisors, clinicians) are conducted. An online pretraining overview of AF-CBT (4, 1-hour videos with option for CEUs) provides an initial overview of AF-CBT. A training request form can be submitted online through their website, www.afcbt.org.

Number of days/hours:

Trainings are tailored to the needs/backgrounds of the practitioner or program, but often include the following components:

  • Practice Readiness and Preparation Phase (2-4 months prior to training):
    • Agency readiness calls and launch activities to prepare organization & leadership team (administrators, supervisors, clinicians)
    • Stakeholder engagement (public relations information/marketing)
    • Staff completion of online pretraining evaluation
    • Staff review of online AF-CBT Orientation video
    • Staff preview of AF-CBT materials (session guide, handouts, screening/assessment tools); with optional collection of agency metrics
    • Development of training materials (slides) and exercises tailored to agency/population
  • Intensive Skills-Training Program (1 year):
    • Basic Training workshop (“learning session”) on use of AF-CBT (2 days)
    • Advanced Training workshop (“booster”) - 6 months later (1/2 day; live or via videoconference)
    • Case consultation calls with trainer (usually, 1/month for 12 months with 2 presentations/call; could be more frequent in less time)
    • Fidelity monitoring feedback based on trainer reviews of digital audio files uploaded by each trainee to our secure website (2 files/trainee)
    • Supervisor consultation and support calls (4-6/year)
    • Online access to the trainer for Q&A and to receive new/updated materials (screening, assessment, treatment, and monitoring materials/forms)
  • Performance Review and Summary (follow-up):
    • Clinician certification review feedback and technical assistance
    • Staff completion of online post-training evaluation and agency metrics (follow-up)
    • Program summary report to agency with feedback/recommendations and next steps

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) as listed below:

The pre-implementation materials include:

  • A pre-training launch agenda for calls with administrators and supervisors/clinicians
  • A collaborative change framework document that outlines key AF-CBT competences in 3 domains: clinician, family engagement, and organizational capacity/support
  • An overview of the Learning Community training model and an Overview of AF-CBT
  • Relevant empirical papers on the application of AF-CBT to cases referred for child abuse/family conflict and child behavior problems
  • Agency/staff training requirements
  • A family screening and eligibility form
  • Online family assessment measures and procedures
  • PowerPoint files with readiness and orientation information
  • Various flyers and brochures to orient stakeholders and families to AF-CBT
  • Other program support, implementation, and monitoring materials

Please see www.afcbt.org for more information.

Formal Support for Implementation

There is formal support available for implementation of Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) as listed below:

A year-long Learning Community training model is used and includes ongoing consultation and technical assistance by an approved trainer, treatment material updates, e-mail support for Q&A, formal supervisor consultation calls, and access to a provider portal on the program’s website. The trainer also will review any submitted, digital audio session files and provide ongoing feedback both during consultation calls and through written summaries to the clinician. The trainer will review a set of AF-CBT clinician certification requirements (posted on the website, under the certification tab).

Many resources and materials are made available to those agencies or individuals currently participating in a training or who have completed a training through a secure portal in the AF-CBT website. This “members only” portal on the home page provides access to all of their treatment and support materials, including AF-CBT practice checklists, an automated family assessment scoring program, and audio upload instructions.

In addition, there is an “in-house” trainer certification program for those certified clinicians who wish to conduct trainings for new staff in their agencies. The program description can be found on the website under the certification tab.

Fidelity Measures

There are fidelity measures for Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) as listed below:

There are several practice checklists, metrics checklists, agency supervision guidelines, and other procedures or guidelines for trainers who collect fidelity information. Clinicians are encouraged to use the Topic Tracker form (fillable pdf) to briefly document session progress in each treatment topic or content area. Trainers also rate submitted audio files for session performance using individual fidelity forms developed for each treatment topic. Most of these measures are available for members only (trainees or trainers) at www.afcbt.org.

Implementation Guides or Manuals

There are implementation guides or manuals for Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) as listed below:

The AF-CBT Session Guide includes implementation guidelines. There also is an implementation guide for working with foster caregivers, a summary of guidelines for the administration and scoring of the assessment measures, and a set of audio file upload and sharing guidelines. The website also includes pdf documents (both those that can be filled out and those that cannot) with all assessment measures, session handouts, safety monitoring forms, and other progress monitoring documents. Most of these are available through the “members only” portal at www.afcbt.org.

Implementation Cost

The program representative did not provide information regarding studies of the costs of implementing Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT).

Research on How to Implement the Program

Research has been conducted on how to implement Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) as listed below:

Kolko, D. J., Baumann, B. L., Herschell, A. D., Hart, J., Holden, E., & Wisniewski, S. (2012). Implementation of AF-CBT by community practitioners serving child welfare and mental health: A randomized trial. Child Maltreatment, 17(1), 30–44. https://doi.org/10.1177/1077559511427346

Relevant Published, Peer-Reviewed Research

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

Kolko, D. J. (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. https://doi.org/10.1177/1077559596001004004

Type of Study: Randomized controlled trial
Number of Participants: 47 parent-child dyad

Population:

  • Age — Child: Mean=8.6 years, Adult: Not specified
  • Race/Ethnicity — Child: 47% African American, 47% Caucasian, and 6% Biracial; Adult: Not specified
  • Gender — Child: 28 Male and 10 Female; Adult: Not specified
  • Status — Participants were families referred by Child Protective Services or other agency for physical abuse.

Location/Institution: Pittsburgh, Pennsylvania

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of the study was to examine the clinical course of families who receive individual child and parent cognitive-behavioral treatment (CBT; now called Alternatives for Families: A Cognitive-Behavioral Therapy [AF-CBT]) and family therapy (FT) to minimize abusive behavior and/or the psychological consequences of child physical abuse (CPA). Participants were randomly assigned to the CBT or FT conditions. There was also a nonrandom group of families who requested and then received routine community services (RCS) through a local provider of their selection. Measures utilized include the Conflict Tactics Scale (CTS), the Weekly Report of Abuse Indicators (WRAI), the Child Abuse Potential Inventory, 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), the Children’s Hostility Inventory, the Global Assessment Scale (GAS), the Brief Symptom Inventory (BSI), the Beck Depression Inventory (BDI), the Child Rearing Interview (CRI), the Parenting Scale (PS), the Parent Opinion Questionnaire (POQ), the Family Environment Scale (FES), and the Family Assessment Device (FAD). Assessments were taken pretreatment and posttreatment and at 3-month and 1-year follow-ups. Results indicate that compared to RCS, the CBT and FT conditions showed significantly greater improvements in parent-to-child violence, parental distress and abuse risk, child externalizing problems, and family conflict and cohesion. The CBT and FT conditions had a lower rate of recurrence of abuse (5% and 6%) than RCS (30% one year after the completion of treatment) but the difference was not statistically significant. All three groups showed other improvements over time. Limitations include small sample size, reliance on self-reported measures, and treatment course measures evaluated only a few of the various forms of verbal and physical discipline/force in which parents routinely engage and did not distinguish among behaviors varying in severity or seriousness.

Length of postintervention 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. https://doi.org/10.1016/0145-2134(95)00113-1

Type of Study: Randomized controlled trial
Number of Participants: 38 parent-child dyads

Population:

  • Age — Child: Mean=8.6 years; Adults: Not specified
  • Race/Ethnicity — Child: 50% Caucasian, 42% African American, and 8% Biracial; Adults: Not specified
  • Gender — Child: 72% Males and 28% Females; Adults: Not specified
  • Status — Participants were referred by Child Protective Services, caseworker, other agency or self-referred.

Location/Institution: Pennsylvania

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The participants in this study are a subsample from Kolko (1996a). The purpose of the study was to examine the clinical course of families who receive individual child and parent cognitive-behavioral treatment (CBT; now named Alternatives for Families: A Cognitive-Behavioral Therapy [AF-CBT]) and family therapy (FT) to minimize abusive behavior and/or the psychological consequences of child physical abuse (CPA). Families were randomly assigned to receive either CBT or FT. Measures utilized include the Conflict Tactics Scale (CTS), the Family Environment Scale (FES), the Child Abuse Potential Inventory (CAP), the Parenting Scale (PS), and the Beck Depression Inventory (BDI). Results indicate 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 significantly greater improvement. Limitations include small sample size and reliance on self-report measures.

Length of postintervention follow-up: None.

Kolko, D. J., Iselin, A. M., & Gully, K. (2011). Evaluation of the Sustainability and Clinical Outcome of Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) in a Child Protection Center. Child Abuse & Neglect, 35(2), 105-116. https://doi.org/10.1016/j.chiabu.2010.09.004

Type of Study: One-group pretest-posttest
Number of Participants: 52 parent-child dyad

Population:

  • Age — Children: 3-17 years (Mean=9.1 years); Adults: Not specified
  • Race/Ethnicity — Children: 88.6% Caucasian, 3.8% Asian, 3.8% Multiracial, 1.9% African-American, and 1.9% Native American; Adults: Not specified
  • Gender — Children: 51.9% Male and 48.1% Female; Adults: Not specified
  • Status — Families receiving therapeutic services from seven therapists in a child protection program located in the Western United States.

Location/Institution: Salt Lake City, Utah

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of the study was to examine the sustainability and outcome of Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT). Measures utilized include the Child Behavior Checklist for Ages 6-18, Trauma Symptom Checklist for Children, and Child Sexual Behavior Inventory, as well as measures of the use of all five treatments: AF-CBT, Parent-Child Interaction Therapy adapted for use with physical abuse (PCIT), Child Parent Psychotherapy (CPP), Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT), and Cognitive-Behavioral Intervention for Trauma in Schools (CBITS) which documented their frequency, internal consistency, and intercorrelations. Results indicate that controlling for the unique content of the other four treatments (TF-CBT, PCIT, CPP, CBITS) the amount of AF-CBT abuse-specific content delivered was significantly related to improvements on standardized parent rating scales (e.g., child externalizing behavior, anger, anxiety, social competence) and both parent and clinician ratings of the child’s adjustment at discharge (e.g., child is safer, less scared/sad, caregiver is more appropriate and respectful of privacy with peers). The amount of AF-CBT general content was related to a few discharge ratings (e.g., better child prognosis, helpfulness to parents). Limitations include small sample size, lack of control group, and lack of follow-up.

Length of postintervention follow-up: None.

Kolko, D. J., Herschell, A. D., Baumann, B. L., Hart, J. A., & Wisniewski, S. R. (2018). AF-CBT for families experiencing physical aggression or abuse served by the mental health or child welfare system: An effectiveness trial. Child Maltreatment, 23(4), 319-333. https://doi.org/10.1177/1077559518781068

Type of Study: Randomized controlled trial
Number of Participants: Providers:182; Families: 195

Population:

  • Age — Child: 5-15 years; Provider & Adult: Not specified
  • Race/Ethnicity — Child, Provider & Adult: Not specified
  • Gender — Child, Provider & Adult: Not specified
  • Status — Participants were providers specializing in AF-CBT and families that were referred from the mental health or child welfare system.

Location/Institution: Two neighboring counties in Pennsylvania

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study was to evaluate the effectiveness of Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) for families who are at risk of or have histories of child physical abuse. A total of 182 providers were randomized to one of the two conditions. AF-CBT and treatment as usual (TAU) had comparable percentages of providers from mental health services (MHS) agencies (n=57, 48) and child welfare services (CWS) agencies (n=33, 44), respectively. Families were not randomized. Measures utilized include the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS), the Parent-Child Conflict Tactics Scale (CTSPC), the Child PTSD Symptom Scale (CPSS), the Alabama Parenting Questionnaire (APQ), the Weekly Report of Abuse Indicators (WRAI), the Brief Child Abuse Potential (B-CAP) Inventory, the Family Assessment Device (FAD), and the Family Conflict subscale. Results indicate that AF-CBT (vs. TAU) showed improvements in both service systems (e.g., abuse risk, family dysfunction) or one service system (e.g., threats of force, child to parent minor assault), with some outcomes showing no improvement (e.g., parental anger). Limitations include families received services that varied by content, dose, duration, staff, and setting, yielding a diverse AF-CBT condition, staff turnover limited the completion of service delivery to some families, and recruitment time frames limited follow-up data collection.

Length of postintervention follow-up: 12 months.

Additional References

Berkout, O., & Kolko, D. J. (2016). Understanding child directed caregiver aggression: An examination of characteristics and predictors associated with perpetration. Child Abuse & Neglect, 56, 44–53. https://doi.org/10.1016/j.chiabu.2016.04.004

Jackson, C. B., Brabson, L. A., Herschell, A. D., & Kolko, D. J. (2019). Application of Alternatives for Families: A Cognitive Behavior Therapy to school settings. In S. G. Little & A. Akin-Little (Eds.), Behavioral interventions in schools: Evidence-based positive strategies (2nd ed.) American Psychological Association.

Kolko, D. J., Fitzgerald, M., & Laubach, J. (2014). Evidence-based practices for working with physically abusive families: Alternatives for Families: A Cognitive Behavioral Therapy. In R. M. Reece, R. F. Hanson, & J. Sargent (Eds.). Treatment of child abuse: Common ground for mental health, medical, and legal practitioners (2nd ed., pp. 59–66). Johns Hopkins University Press.

Contact Information

David J. Kolko, PhD, ABPP
Agency/Affiliation: University of Pittsburgh, School of Medicine
Department: Department of Psychiatry
Website: www.afcbt.org
Email:
Phone: (412) 246-5888
Fax: (412) 246-5341
Elissa J. Brown, PhD
Agency/Affiliation: St. John’s University,
Department: Dept. of Psychology
Website: www.childhelppartnership.org
Email:
Phone: (718) 990-2355
Fax: (718) 990-1586

Date Research Evidence Last Reviewed by CEBC: June 2019

Date Program Content Last Reviewed by Program Staff: July 2019

Date Program Originally Loaded onto CEBC: May 2006