Child-Parent Psychotherapy (CPP)

About This Program

Target Population: Children age 0-5, who have experienced a trauma, and their caregivers

For children/adolescents ages: 0 – 5

For parents/caregivers of children ages: 0 – 5

Program Overview

CPP is a treatment for trauma-exposed children aged 0-5. Typically, the child is seen with his or her primary caregiver, and the dyad is the unit of treatment. CPP examines how the trauma and the caregivers’ relational history affect the caregiver-child relationship and the child’s developmental trajectory. A central goal is to support and strengthen the caregiver-child relationship as a vehicle for restoring and protecting the child’s mental health. Treatment also focuses on contextual factors that may affect the caregiver-child relationship (e.g., culture and socioeconomic and immigration related stressors). Targets of the intervention include caregivers’ and children’s maladaptive representations of themselves and each other and interactions and behaviors that interfere with the child’s mental health. Over the course of treatment, caregiver and child are guided to create a joint narrative of the psychological traumatic event and identify and address traumatic triggers that generate dysregulated behaviors and affect.

Program Goals

The program representative did not provide information about the program’s goals.

Essential Components

The essential components of Child-Parent Psychotherapy (CPP) include:

  • Focus on the parent-child relationship as the primary target of intervention.
  • Focus on safety: a) Focus on safety issues in the environment as needed; b) Promote safe behavior; c) Legitimize feelings while highlighting the need for safe/appropriate behavior; d) Foster appropriate limit setting; e) Help establish appropriate parent-child roles.
  • Affect regulation: a) Provide developmental guidance regarding how children regulate affect and emotional reactions; b) Support and label affective experiences; c) Foster parent's ability to respond in helpful, soothing ways when child is upset; d) Foster child's ability to use parent as a secure base; e) Develop/foster strategies for regulating affect.
  • Reciprocity in Relationships: a) Highlight parent's and child's love and understanding for each other; b) Support expression of positive and negative feelings for important people; c) Foster ability to understand the other's perspective; d) Talk about ways that parent and child are different and autonomous; e) Develop interventions to change maladaptive patterns of interactions.
  • Focus on the traumatic event: a) Help parent acknowledge what child has witnessed and remembered; b) Help parent and child understand each other's reality with regards to the trauma; c) Provide developmental guidance acknowledging response to trauma; d) Make linkages between past experiences and current thoughts, feelings, and behaviors; e) Help parent understand link between her own experiences and current feelings and parenting practices; f) Highlight the difference between past and present circumstances; g) Support parent and child in creating a joint narrative; h) Reinforce behaviors that help parent and child master the trauma and gain a new perspective.
  • Continuity of Daily Living: a) Foster prosocial, adaptive behavior; b) Foster efforts to engage in appropriate activities; c) Foster development of a daily predictable routine.
  • Reflective supervision

Program Delivery

Child/Adolescent Services

Child-Parent Psychotherapy (CPP) directly provides services to children/adolescents and addresses the following:

  • Exposure to trauma, internalizing and externalizing symptoms, and/or symptoms of posttraumatic stress disorder (PTSD)

Parent/Caregiver Services

Child-Parent Psychotherapy (CPP) directly provides services to parents/caregivers and addresses the following:

  • Negative attributions about the child, problems in the parent-child relationship, and maladaptive parenting strategies. In addition, when appropriate, the program targets parental symptoms including PTSD symptoms (avoidance, intrusion, and hyperarousal), depression, and anxiety

Recommended Intensity:

Weekly 1 to 1.5-hour sessions

Recommended Duration:

52 weeks (one year)

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Foster / Kinship Care
  • Outpatient Clinic
  • Community-based Agency / Organization / Provider
  • School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

This program does not include a homework component.

Resources Needed to Run Program

The typical resources for implementing the program are:

No specific room requirements are needed as the program is often implemented through a home-visiting model.

Education and Training

Prerequisite/Minimum Provider Qualifications

  • Practitioners: Master's level training
  • Supervisors: Master's degree plus minimum of 1 year training in the model

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:

There are a number of different training models. Training occurs can be arranged through the Child Trauma Research Program by contacting the individual above. Training also occurs through the Learning Collaborative model of the National Child Traumatic Stress Network. In general, training is tailored to the needs of the organization.

Number of days/hours:

Typically training involves an initial 3-day workshop and then quarterly (3 more times in a year) 2-day additional workshops. In addition, training involves bi-monthly telephone-based case consultation of ongoing treatment cases involving children aged 0-5 who have experienced a trauma.

Implementation Information

Pre-Implementation Materials

The program representative did not provide information about pre-implementation materials.

Formal Support for Implementation

The program representative did not provide information about formal support for implementation of Child-Parent Psychotherapy (CPP).

Fidelity Measures

The program representative did not provide information about fidelity measures of Child-Parent Psychotherapy (CPP).

Implementation Guides or Manuals

The program representative did not provide information about implementation guides or manuals for Child-Parent Psychotherapy (CPP).

Research on How to Implement the Program

The program representative did not provide information about research conducted on how to implement Child-Parent Psychotherapy (CPP).

Relevant Published, Peer-Reviewed Research

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

When more than 10 research articles have been published in peer-reviewed journals, the CEBC reviews all of the articles as part of the rating process and identifies the most relevant articles, with a focus on randomized controlled trials (RCTs) and controlled studies that have an impact on the rating. The 14 articles chosen for Child-Parent Psychotherapy are summarized below:

Lieberman, A. F., Weston, D. R., & Pawl, J. H. (1991). Preventive interaction and outcome with anxiously attached dyads. Child Development, 62, 199-209. doi:10.1111/j.1467-8624.1991.tb01525.x 

Type of Study: Randomized controlled trial
Number of Participants: 93 mother-child pairs

Population:

  • Age — Children: 11-14 months, Adults: 21-39 years
  • Race/Ethnicity — Children: Not specified, Adults: 100% Mexican and Central American
  • Gender — Children: 44% Male, Adults: 100% Female
  • Status — Participants were mothers who were recent immigrants with low socioeconomic status (SES) and recruited from pediatric clinics.

Location/Institution: California

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study was to test the efficacy of Infant-Parent Psychotherapy [now called Child-Parent Psychotherapy (CPP)] in mother-infant pairs who were anxiously attached. Participants were randomly assigned to either the Infant-Parent Psychotherapy intervention group or a nonintervention control group. Measures utilized include the Strange Situation, the Maternal Attitude Scale, and the Life Event Inventory. A second control group was also formed, consisting of pairs who were found at baseline to be securely attached. Results indicate that intervention group pairs had higher scores in empathic responsiveness and goal-corrected partnership and lower scores on angry behavior by the child than anxious control pairs. The intervention group did not differ from the anxious control group on attachment security, although intervention children were less likely to show proximity avoidance and contact resistance. Both the intervention group and anxious control group improved in maternal child-rearing attitudes over time. Although the secure control group still had higher secure attachment scores at the follow-up than the intervention group, the two groups did not differ significantly on other outcomes at the end of the intervention. Limitations include small sample, lack of postintervention follow-up, and lack of generalizability.

Length of postintervention follow-up: None.

Cicchetti, D., Toth, S. L., & Rogosch, F. A. (1999). The efficacy of Toddler-Parent psychotherapy to increase attachment security in off-spring of depressed mothers. Attachment & Human Development, 1(1), 34-66. doi:10.1080/14616739900134021 

Type of Study: Randomized controlled trial
Number of Participants: 108 mother-child pairs

Population:

  • Age — Children: Mean=20.4 months (approx. 1.7 years), Adult: 22-41 years
  • Race/Ethnicity — Children: Not specified, Adults: 95.4% Caucasian
  • Gender — Children: 50% Male and 50% Female, Adults: 100% Female
  • Status — Participants were depressed mothers with at least a high school education recruited through media and referrals from mental health professionals or mothers who lived in the vicinity of these mothers that were screened to create the nondepressed control group.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study was to test the efficacy of Toddler-Parent Psychotherapy [now called Child-Parent Psychotherapy (CPP)] in depressed mothers of young children. Participants were randomly assigned to receive Toddler-Parent Psychotherapy or to a nonintervention control group. There was also a second control group of mothers from the same community who did not have any prior diagnosis of a mental disorder. Measures utilized include the Diagnostic Interview Schedule (DIS-III-R), the Beck Depression Inventory (BDI), and the Attachment Q-set (AQS). Results indicate that both the intervention and depressed control groups had a higher proportion of insecurely attached children than the nondepressed control at baseline. At follow-up, the intervention group's proportion of insecurely attached children had decreased to the point that it was no longer significantly different from that of the nondepressed control group, while the depressed control group experienced an increase in insecure attachment. This study is somewhat limited by the decision to omit mothers from low socioeconomic groups and the use of a more subjective method of classifying children's attachment. Limitations include small sample size, lack of postintervention follow-up, and lack of generalizability.

Length of postintervention follow-up: None.

Cicchetti, D., Rogosch, F. A., & Toth, S. L. (2000). The efficacy Toddler-Parent Psychotherapy for fostering cognitive development in offspring of depressed mothers. Journal of Abnormal Child Psychology, 28(2), 135-148. doi:10.1023/A:1005118713814 

Type of Study: Randomized controlled trial
Number of Participants: 158 mother-child pairs

Population:

  • Age — Children: Mean=20.47 months (approx. 1.71 years), Adults: 22-41 years
  • Race/Ethnicity — Children: Not specified, Adults: 92.4% Caucasian
  • Gender — Children: 81 Boys and 77 Girls, Adults: 100% Female
  • Status — Participants were mothers of non-low socioeconomic status recruited through mental health professionals and the media or mothers who lived in the vicinity of these mothers that were screened to create the nondepressed control group.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study includes sample from Cicchetti et al. (1999). The purpose of this study was to test the efficacy of Toddler-Parent Psychotherapy [now called Child-Parent Psychotherapy (CPP)] in depressed mothers of young children. Participants were randomly assigned to either Toddler-Parent Psychotherapy (DI group) or a nonintervention group (DC group). In addition, a control group of mothers with no history of psychiatric disorder was formed (NC group). Measures utilized include the Diagnostic Interview Schedule (DIS-III-R), the Beck Depression Inventory (BDI), the Bayley Mental Development Index (MDI), and the Wechsler Preschool and Primary Scales of Intelligence (WPPSI-R). Results indicate that, although there were no differences in child intelligence across groups at baseline, differences in cognitive functioning were obtained at age 3. The depressed control group diverged from the normal comparison group, and evidenced a relative decline in age-expected cognitive skills, particularly if their mothers had a subsequent depressive episode. Limitations include small sample size, lack of postintervention follow-up, and lack of generalizability.

Length of postintervention follow-up: None.

Toth, S. L., Maughan, A., Manly, J. T., Spagnola, M., & Cicchetti, D. (2002). The relative efficacy of two interventions in altering maltreated preschool children's representational models: Implications for attachment theory. Development and Psychopathology, 14, 877-908. doi:10.1017/S095457940200411X 

Type of Study: Randomized controlled trial
Number of Participants: 122 mother-child pairs

Population:

  • Age — Children: Mean=48.14 months (approx. 4.0 years), Adults: Not specified
  • Race/Ethnicity — Children: 76.2% Minority and 27.8% Nonminority, Adults: Not specified
  • Gender — Children: 68 Boys and 54 Girls, Adults: 100% Female
  • Status — Participants were families with a documented history of maltreatment recruited from the Department of Social Services or randomly recruited from families receiving Temporary Assistance to Needy Families (TANF) and screened for history of maltreatment.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study was to test the efficacy of Preschooler-Parent Psychotherapy (PPP) [now called Child-Parent Psychotherapy (CPP)]. Participants were randomly assigned to the PPP, psychoeducational home visitation (PHV), or community standard (CS) groups. A comparison group (NC) of low-income mothers and children with no history of maltreatment was also included. Measures utilized include the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-R). Results indicated that the PPP children showed reductions in problematic maternal representations compared to PHV group children and greater reductions in negative self-representations compared to all other groups. Mother-child relationship expectations also became more positive than for the NC and PHV groups. Limitations include small sample size and lack of postintervention follow-up.

Length of postintervention follow-up: None.

Lieberman, A. F., Van Horn, P., & Ghosh Ippen, C. (2005). Toward evidence-based treatment: Child-Parent Psychotherapy with preschoolers exposed to marital violence. Journal of the American Academy of Child and Adolescent Psychiatry, 44(12), 1241-1448. doi:10.1097/01.chi.0000181047.59702.58 

Type of Study: Randomized controlled trial
Number of Participants: 75 mother-child pairs

Population:

  • Age — Children: 3-5 years, Adults: Not specified
  • Race/Ethnicity — Children: Children: 38.7% Mixed Ethnicity, 28% Latino, 14.7% African American, 9.3% White, 6.7% Asian, and 2.6% Other; Adults: 37.3% Latina, 24% White, 14.7% African American, 10.7% Asian, 13.3% Mixed or Other
  • Gender — Children: 39 Girls and 36 Boys, Adults: 100% Female
  • Status — Participants were referred by court, Child Protective Services (CPS), or other community services after child witnessed marital violence.

Location/Institution: California

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study was to test the efficacy of Child-Parent Psychotherapy (CPP). Participants were randomly assigned to either the CPP treatment group or to a comparison group receiving case management and referral to individual treatment in the community for mother and child. Measures utilized include the Child's Exposure to Community Violence: Parent Report Version, the Child Behavior Checklist (CBCL), the Semistructured Interview for Diagnostic Classification DC: 0-3 for Clinicians, the Life Stressor Checklist, the Clinician Administered PTSD Scale, and the Symptoms Checklist-90. Results indicate that CPP group children showed a significant decline in posttraumatic stress disorder (PTSD) symptoms and behavior problems at the conclusion of the study, while comparison group children did not. Mothers in the CPP group showed significant reductions in avoidant symptoms and there was a moderate effect on general distress and PTSD symptoms. Limitations include a small sample, lack of postintervention follow-up, and reliance on maternal report.

Length of postintervention follow-up: None.

Cicchetti, D., Rogosh, F. A., & Toth, S. L. (2006). Fostering secure attachment in infants in maltreating families through preventive interventions. Development and Psychopathology, 18, 623-649. doi:10.1017/S0954579406060329 

Type of Study: Randomized controlled trial
Number of Participants: 189 mother-child pairs

Population:

  • Age — Children: Mean=13.3 months, Adults: Mean=28.67 years
  • Race/Ethnicity — Children: Not specified, Adults: 74.1% Minority Race/Ethnicity
  • Gender — Children: 101 Girls and 88 Boys, Adults: 100% Female
  • Status — Participants were infants in maltreating families and their mothers recruited through a Department of Human Services (DHS) liaison or through the Temporary Assistance to Needy Families (TANF) rolls.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study was to test the efficacy of Infant Parent Psychotherapy (IPP) [now called Child-Parent Psychotherapy (CPP)]. Participants were randomly assigned to receive IPP, psychoeducational parenting intervention (PPI), or to a community standards control group (CS). An additional comparison group (NC) from low-income nonmaltreating families was also included. Measures utilized include the Childhood Trauma Questionnaire (CTQ), the Perceptions of Adult Attachment Scale (PAAS), the Maternal Behavior Q-Set (MBQ), the Adult-Adolescent Parenting Inventory (AAPI), the Social Support Behaviors Scale (SSBS), the Parenting Stress Inventory (PSI), and the Strange Situation. Results indicate that at baseline, infants in the maltreatment groups showed higher levels of disorganized attachment. At postintervention, children in the IPP and PPI groups showed significant increases in levels of secure attachment, relative to the CS and NC groups. Limitations include lack of postintervention follow-up and inconsistent maternal engagement in intervention.

Length of postintervention follow-up: None.

Lieberman, A. F., Ghosh Ippen, C., & Van Horn, P. (2006). Child-Parent Psychotherapy: 6-month follow-up of a randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 45(8), 913-918. doi:10.1097/01.chi.0000222784.03735.92 

Type of Study: Randomized controlled trial
Number of Participants: 50 mother-child pairs

Population:

  • Age — Children: 3-5 years, Adults: Not specified
  • Race/Ethnicity — Children: 38% Mixed Ethnicity, 28% Latino, 16% African American, 12% White, 4% Asian, and 2% Other; Adults: 37.3% Latina, 24% White, 14.7% African American, 10.7% Asian, and 13.3% Mixed or Other
  • Gender — Children: 28 Boys and 22 Girls, Adults: 100% Female
  • Status — Participants were referred by court, Child Protective Services (CPS), or other community services after child witnessed marital violence.

Location/Institution: California

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study uses the same sample as Lieberman et al. (2005). The purpose of this study was to test the efficacy of Child-Parent Psychotherapy (CPP). Participants were randomly assigned to either the CPP treatment group or to a comparison group. Measures utilized include the Child Behavior Checklist (CBCL) and the Global Severity Index (GSI). Results indicate that in a comparison of baseline and 6-month follow-up scores, the CPP treatment children showed significant reductions in problems behaviors while the control group did not. Similarly, only the CPP group mothers showed a significant improvement in distress levels at 6 months. Limitations include small sample size and reliance on maternal report.

Length of postintervention follow-up: 6 months.

Toth, S. L., Rogosch, F. A., Manly, J. T., & Cicchetti, D. (2006). The efficacy of toddler-parent psychotherapy to reorganize attachment in the young offspring of mothers with major depressive disorder: A randomized preventive trial. Journal of Consulting and Clinical Psychology, 74(6), 1006-1016. doi:10.1037/0022-006X.74.6.1006 

Type of Study: Randomized controlled trial
Number of Participants: 198 mother-child pairs

Population:

  • Age — Children: Mean=20.34 months (approx. 1.65 years), Adults: Mean=31.68 years
  • Race/Ethnicity — Children: Not specified, Adults: 92.9% European American
  • Gender — Children: 52.8% Boys and 47.2% Girls, Adults: 100% Female
  • Status — Participants were mothers of non-low socioeconomic status recruited through mental health professionals and the media or mothers who lived in the vicinity of these mothers that were screened to create the nondepressed control group.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study includes participants from Cicchetti et al. (1999). The purpose of this study was to test the efficacy of Toddler-Parent Psychotherapy [now called Child-Parent Psychotherapy (CPP)] in depressed mothers of young children. Participants were randomly assigned to Toddler-Parent Psychotherapy (DI) or the nonintervention (DC) groups. A control group of nondepressed mothers (NC) was also created by directly contacting families. Measures utilized include the Diagnostic Interview Schedule (DIS-III-R), the Beck Depression Inventory (BDI) and the Strange Situation. Results indicate that both groups with depressed mothers showed insecure attachment at baseline. At postintervention, the rate of secure attachment in the DI group was higher than both the NC and DC groups. Limitations include generalizability to higher risk populations, small sample size, and lack of postintervention follow-up.

Length of postintervention follow-up: None.

Weiner, D. A., Schneider, A., & Lyons, J. S. (2009). Evidence-based treatments for trauma among culturally diverse foster care youth: Treatment retention and outcomes. Children and Youth Services Review, 31(11), 1199-1205. doi:10.1016/j.childyouth.2009.08.013

Type of Study: Randomized controlled trial
Number of Participants: 65 children

Population:

  • Age — Children: 0-6 years
  • Race/Ethnicity — Children: 35 African American, 19 Hispanic, 19 White, and 9 Biracial
  • Gender — Children: 49.1% Boys and 50.9% Girls
  • Status — Participants were in a wraparound foster care program.

Location/Institution: 6 agencies that provide System of Care wraparound programs that were selected by the Illinois Department of Children and Family Services (IDCFS)

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study tests the efficacy of three treatments: Child Parent Psychotherapy (CPP), Trauma-Focused Cognitive Behavioral Treatment (TF-CBT), and Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS). Participants were randomized to one of the three conditions. Measures utilized include the Child and Adolescent Needs and Strengths (CANS), the Brief Infant Toddler Social Emotional Assessment (BITSEA), the Youth Outcomes Questionnaire (YOQ), the Devereux Early Childhood Assessment Clinical Form (DECA-C), and the UCLA-PTSD measure. Results indicated that CPP was universally effective across racial/ethnic subgroups. CPP significantly reduced placement interruptions. Limitations include generalizability, small sample size, and attrition.

Length of postintervention follow-up: 6 months.

Ippen, C. G., Harris, W. W., Van Horn, P., & Lieberman, A. F. (2011). Traumatic and stressful events in early childhood: Can treatment help those at highest risk?. Child Abuse & Neglect, 35(7), 504-513. doi:10.1016/j.chiabu.2011.03.009

Type of Study: Randomized controlled trial
Number of Participants: 75 child-mother dyads

Population:

  • Age — Children: 3-5 years, Mothers: Mean = 31.48 years
  • Race/Ethnicity — Children: 38.7% Mixed Ethnicity, 28% Latino, 14.7% African American, 9.3% White, 6.7% Asian, and 2.6% Other; Adults: 37.3% Latina, 24% White, 14.7% African American, 10.7% Asian, and 13.3% Mixed or Other
  • Gender — Children: 39 Girls and 36 Boys, Adults: 100% Female
  • Status — Participants were referred by court, Child Protective Services (CPS), or other community services after child witnessed marital violence.

Location/Institution: California

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study reanalyzed data from a previous study done by Lieberman et al. (2005). This study tests of efficacy of Child Parent Psychotherapy (CPP). Participants were randomly assigned to either the CPP treatment group or to a comparison group. Measures utilized the Child's Exposure to Community Violence: Parent Report Version, the Child Behavior Checklist (CBCL), the Semistructured Interview for Diagnostic Classification DC: 0-3 for Clinicians, the Life Stressor Checklist, the Clinician Administered PTSD Scale, and the Symptoms Checklist-90. Traumatic and stressful events (TSEs) were calculated through acestudy.org. Results indicated that the CPP group children exposed to 4+ TSEs showed a significant improvement on posttraumatic stress disorder (PTSD) and depression symptoms and behavior problems at the conclusion of the study, while comparison group children did not. Children with exposure to fewer TSEs also showed significant improvement. Mothers in the CPP group showed significant reductions in avoidant symptoms and there was a moderate effect on general distress and PTSD symptoms. Limitations include a small sample, reliance on maternal report, and dichotomizing children into only two TSE risk groups.

Length of postintervention follow-up: 6 months.

Cicchetti, D., Rogosch, F. A., Toth, S. L., & Sturge-Apple, M. L. (2011). Normalizing the development of cortisol regulation in maltreated infants through preventive interventions. Development and Psychopathology, 23(3), 789-800. doi:10.1017/S0954579411000307

Type of Study: Randomized controlled trial
Number of Participants: 143 mother-child pairs

Population:

  • Age — Children: Mean=13.3 months, Mothers: Mean=26.9 years
  • Race/Ethnicity — Children: Not specified, Adults: 72.5% Minority Race/Ethnicity
  • Gender — Children: Not specified, Adults: 100% Female
  • Status — Participants were infants in maltreating families and their mothers recruited through a Department of Human Services (DHS) liaison or through the Temporary Assistance to Needy Families (TANF) rolls.

Location/Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study utilized a subset of participants from Cicchetti et al. (2006). This study tests the efficacy of Child-Parent Psychotherapy (CPP). Participants from maltreating families were randomly assigned to receive CPP, a psychoeducational parenting intervention (PPI), or to a community standards control group (CS). An additional comparison group (NC) from low-income nonmaltreating families was also included. Measures include the Maternal Maltreatment Classification Interview. Saliva samples to measure cortisol levels were obtained from children at 10:00 a.m. before beginning a laboratory observation session with their mothers when the children were 13 months of age (preintervention), 19 months (midintervention), 26 months (postintervention), and 38 months (1-year postintervention follow-up). Results indicate that the CPP and PPI group revealed the same levels of morning cortisol as the nonmaltreated control group, while the CS control group showed statistically significant lower levels of morning cortisol. Limitations include only using one cortisol sample per time period, the non-inclusion of other biomarkers of allostatic load, inability to delineate definitive mechanisms of change that contributed to the differential patterns of cortisol regulation, and the lack of generalizability due to the exclusion of maltreated infants in foster care in this study.

Length of postintervention follow-up: 1 year.

Stronach, E. P., Toth, S. L., Rogosch, F., & Cicchetti, D. (2013). Preventive interventions and sustained attachment security in maltreated children. Development and Psychopathology, 25(4pt1), 919-930. doi:10.1017/S0954579413000278

Type of Study: Randomized controlled trial
Number of Participants: 137 mother-child pairs

Population:

  • Age — Children: Mean=13.3 months, Mothers: Mean=26.9 years
  • Race/Ethnicity — Children: 60.3% African-American, 17.5% White, 5.8% Latino, 16.4% Biracial/Other; Mothers: 53.9% African-American, 25.4$ White, 12.2% Latino, 8.5% Biracial/Other
  • Gender — Children: Not specified, Adults: 100% Female
  • Status — Participants were infants in maltreating families and their mothers recruited through a Department of Human Services (DHS) liaison or through the Temporary Assistance to Needy Families (TANF) rolls.

Location/Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study tests the efficacy of Child-Parent Psychotherapy (CPP). Participants were randomly assigned to receive CPP, a psychoeducational parenting intervention (PPI), or to a community standards control group (CS). An additional comparison group (NC) from low-income nonmaltreating families was also included. Measures utilized include the Strange Situation paradigm, the Attachment Organization in Preschool Children: Procedures and Coding Manual, the Childhood Trauma Questionnaire—Short Form (CTQSF), the Diagnostic Interview Schedule—Version IV (DIS-IV), and the Child Behavior Checklist/2–3 (CBCL). Results indicate the CPP group revealed higher rates of secure attachment and the maintenance of secure attachment in children 1 year after the conclusion of intervention. Limitations include lack of generalizability, small sample size, and lack of study replication.

Length of postintervention follow-up: 1 year.

Toth, S. L., Sturge-Apple, M. L., Rogosch, F. A., & Cicchetti, D. (2015). Mechanisms of change: Testing how preventative interventions impact psychological and physiological stress functioning in mothers in neglectful families. Development and Psychopathology, 27(4pt2), 1661-1674. doi:10.1017/S0954579415001017

Type of Study: Randomized controlled trial
Number of Participants: 157 mother-child pairs

Population:

  • Age — Children: Mean=13.3 months, Mothers: Mean=26.9 years
  • Race/Ethnicity — Children: 60.3% African-American, 17.5% White, 5.8% Latino, and 16.4% Biracial/Other; Mothers: 53.9% African-American, 25.4$ White, 12.2% Latino, and 8.5% Biracial/Other
  • Gender — Children: Not specified, Adults: 100% Female
  • Status — Participants were infants in maltreating families and their mothers recruited through a Department of Human Services (DHS) liaison or through the Temporary Assistance to Needy Families (TANF) rolls.

Location/Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study utilized a subset of participants from Cicchetti et al. (2006). This study tests the efficacy of Child-Parent Psychotherapy (CPP). Participants were randomly assigned to receive CPP, a psychoeducational parenting intervention (PPI), or to a community standards control group (CS). An additional comparison group (NC) from low-income nonmaltreating families was also included. Measures included the Parenting Stress Index and mid-morning cortisol samples. Results indicated that the mothers from the CPP group revealed decreased child-related stress from intake to post-intervention. There were no changes in basal cortisol in the CPP group, compared to that of the NC and CS groups, suggesting elevated physiological success. There were also reductions in child-related stress by posttreatment decrease in basal cortisol at follow-up. Limitations include lack of generalizability, small sample size, and only having one cortisol measure at follow-up.

Length of postintervention follow-up: 1 year.

Guild, D. J., Toth, S. L., Handley, E. D., Rogosch, F. A., & Cicchetti, D. (2017). Attachment security mediates the longitudinal association between Child-Parent Psychotherapy and peer relations for toddlers of depressed mothers. Development and Psychopathology, 29(2), 587-600. doi:10.1017/S0954579417000207

Type of Study: Randomized controlled trial
Number of Participants: 130

Population:

  • Age — Child: 8-11 years
  • Race/Ethnicity — 119 White, 5 Black, 4 Hispanic, and 2 Other
  • Gender — Not specified
  • Status — Participants were mothers with a history of major depressive disorder (MDD) since giving birth to their child.

Location/Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study utilized a subset of participants from Cicchetti et al. (1999). The present study examined follow-up data of teachers’ reports on participants’ competence with classroom peers when they were approximately 9 years old to determine postintervention attachment status as a mediator of the association between Child Parent Psychotherapy (CPP) for depressed mothers and their offspring and subsequent peer relations among offspring. Depressed mothers and their toddlers were randomized to receive CPP or to a control group. Measures utilized include the Diagnostic Interview Schedule, Version III, Revised (DIS-III-R), the Beck Depression Inventory (BDI), the BDI-Second Edition (BDI-II), the Strange Situation, and the Teacher Checklist of Peer Relationships (TCPR). Results indicate that children who received CPP were more likely to evidence secure attachments at postintervention, which in turn was associated with more positive peer relationships at age 9. Limitations include concerns about generalizability to children and mothers of different racial/ethnic backgrounds or lower socioeconomic strata, that CPP was compared against a no treatment control condition rather than another active treatment, reliance on teacher report of peer relationships, and high attrition rates at the follow-up timepoint.

Length of postintervention follow-up: Approximately 7.5-8 years.

Additional References

Lieberman, A. F., Compton, N. C., Van Horn, P., & Ghosh Ippen, C. (2003). Losing a parent to death in the early years: Guidelines for the treatment of traumatic bereavement in infancy. Washington D.C.: Zero to Three Press.

Lieberman, A. F., & Van Horn, P. (2004). Don't hit my mommy: A manual for child parent psychotherapy with young witnesses of family violence. Zero to Three Press: Washington, D.C.

Lieberman, A. F., & Van Horn, P. (2008). Psychotherapy with infants and young children: Repairing the effects of stress and trauma on early attachment. New York: The Guilford Press.

Contact Information

Chandra Ghosh Ippen, PhD
Agency/Affiliation: University of California, San Francisco
Department: Child Trauma Research Program
Email:
Phone: (415) 206-5312
Fax: (415) 206-5328

Date Research Evidence Last Reviewed by CEBC: July 2019

Date Program Content Last Reviewed by Program Staff: May 2015

Date Program Originally Loaded onto CEBC: May 2006