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Program Profile: Alternatives for Families: Cognitive Behavioral Therapy

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on June 10, 2011

Program Summary

A comprehensive approach for children and their parents to deal with the effects of child physical abuse, exposure to related abuse, child or family aggression, and hostile family environments. The program is rated Promising. Parents reported less child-to-parent and parent-to-child violence. Children in both treatment groups reported significant reductions for internalizing and externalizing symptoms and parents reported reductions in the belief in the need for physical punishment.

Program Description

Program Goals

Alternatives for Families: Cognitive Behavioral Therapy (AF–CBT; formally Abuse-Focused Cognitive Behavioral Therapy) is a comprehensive approach to dealing with the effects of child physical abuse, exposure to related abuse, child or family aggression, and hostile family environments by reducing risk factors for future abuse while also helping the affected individual to recover from the effects of past abuse. AF–CBT teaches parents and children intrapersonal and interpersonal skills to enhance self-control, promote positive family relations, and reduce violent behavior.

 

Target Population

Traditionally, AF–CBT is meant for children exhibiting behavioral or emotional dysfunction because of exposure to a hostile or physically aggressive family life. It can also be used for children with behavioral disorders such as Conduct Disorder and Oppositional Defiant Disorder even without the presence of violent relationships.

 

Program Components

Previous versions of AF–CBT conducted the individual therapy session separate from the family sessions. Known as Individual Child and Parent cognitive behavioral treatment (CBT), the sessions for the parent and child were conducted separately—using parallel protocols. The joint Family Therapy (FT) sessions were introduced and included components for improving family functioning and relationships.

 

Currently, AF–CBT consists of 3 phases of treatment and 18 session components. Phase 1 concentrates on introduction to and engagement in treatment, psychoeducation, feeling identification, and abuse discussion. Phase 2 teaches new ways of thinking, emotional and behavior management, and how to get along with others. Phase 3 prepares the parents and child for program completion by holding a clarification meeting and teaching problem-solving techniques to use in future situations.

Evaluation Outcomes

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Study 1

Violent Behavior and Child Abuse Risk

Kolko (1996) found that parents reported significantly less child-to-parent and parent-to-child violence over time in the Cognitive Behavioral Therapy (CBT) and Family Therapy (FT) groups, compared with the routine community service (RCS) group. Though both treatment groups showed a consistent reduction in child abuse risk potential, this only approached significance. In comparison, the RCS group had a small drop and then a large increase in risk potential. CBT parents reported thinking of using physical force or discipline significantly less from pretreatment to posttreatment and at the 1 year follow-up than those in the RCS group. FT parents thought significantly less about using force from pretreatment to posttreatment only.

 

Children reported a significant reduction over time in parental anger and reported lower ratings of serious family problems over time for the treatment groups. However, there was no significant change in the number of threats or acts involving physical force.

 

Reabuse

There was no statistically significant difference between the groups on child reabuse. There were 7 case records from the county child abuse agency for the 47 records they received (14.9 percent). One of the seven cases was for physical abuse; the other six were for maltreatment.

 

Child Behavior and Adjustment

Children in the both treatment groups reported significant reductions over time for internalizing and externalizing symptoms. There was no effect found for social skills. Scores on depression were generally low and did not differ significantly between groups. Parents reported significant reduction over time in levels of externalizing symptoms. Children from the CBT group showed the greatest initial change, and those from the FT group showed the greatest change at follow-up, compared with the RCS children.

 

Parenting Skills and Family Functioning

CBT and FT parents reported significant reductions in belief in the need for physical punishment. There was a weak significant increase in level of discipline and in child acceptance.

 

Parents and children reported a significant increase in cohesion scores for the CBT and FT families. Children noted a significant decrease in conflict scores for the FT group as well. There was a significant reduction in the level of family conflict over time as reported by the parents in both treatment groups; conversely, the RCS group saw a significant increase.

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Evaluation Methodology

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Study 1

Kolko (1996) randomly assigned 55 maltreated children and their guardians to one of the following interventions: Individual Child and Parent Cognitive Behavioral Therapy (CBT; n=25), Family Therapy (FT; n=18), or routine community service (RCS; n=12). The FT intervention taught families positive communication skills and how to solve problems by working together. The RCS control families were referred by caseworkers to appropriate local services on the basis of a risk assessment interview.

 

Families were included in the study if there had been a report of physical child abuse, of maltreatment, or of frequent or hash physical force without injury in the past 6 months. Children were 6 to 13 years old, had no developmental or intellectual disorders, were not treated for sexual abuse in the past year, were not participating in similar treatment, were interested and willing to participate in therapy, and resided locally. Guardians had no intellectual or psychiatric disorders, were not involved in a similar treatment program, were interested and willing to participate in therapy, and resided locally.

 

This study evaluated the three groups using measures based on violence and abuse risk, child and parent dysfunction, cognitive behavioral techniques, and family functioning. Interviews were conducted before treatment, immediately after treatment, after 3 months and after 1 year.

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Cost

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There is no cost information available for this program.
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Implementation Information

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Alternatives for Families: Cognitive Behavioral Therapy (AF–CBT) can be implemented in any setting. The most common places are clinics (outpatient and residential), private residences, community centers, and foster programs. Though AF–CBT has been evaluated with white and African American families, it also is used with American Indian, Hispanic, and Asian American families.

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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1

Kolko, David J. 1996a. “Individual Cognitive Behavioral Treatment and Family Therapy for Physically Abused Children and their Offending Parents: A Comparison of Clinical Outcomes.” Child Maltreatment 1:322–42.


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Additional References

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These sources were used in the development of the program profile:

Alternatives for Families: Cognitive Behavioral Therapy, University of Pittsburgh. 2009.
http://www.afcbt.org/

Deblinger, Esther, Julie Lippmann, and Robert A. Steer. 1996. “Sexually Abused Children Suffering Posttraumatic Stress Symptoms: Initial Treatment Outcome Findings.” Child Maltreatment 1:310–21.

Deblinger, Esther, Robert A. Steer, and Julie Lippmann. 1999. “Two-Year Follow-Up Study of Cognitive Behavioral Therapy for Sexually Abused Children Suffering Posttraumatic Stress Symptoms.” Child Abuse and Neglect 23(12):1371–78.

Kolko, David J. 1996b. “Clinical Monitoring of Treatment Course in Child Physical Abuse: Psychometric Characteristics and Treatment Comparisons.” Child Abuse and Neglect 20(1):23–43.

Putnam, Frank W. 2003. “Ten-Year Research Updated Review: Child Sexual Abuse.” Journal of the American Academy of Child and Adolescent Psychiatry 42(3):269–78.

Saywitz, Karen J., Anthony P. Mannarino, Lucy Berliner, and Judith A. Cohen. 2000. “Treatment for Sexually Abused Children and Adolescents.” American Psychologist 55(9):1040–49.
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Program Snapshot

Age: 6 - 13, 18+

Gender: Both

Race/Ethnicity: Black, White

Geography: Rural, Suburban, Urban

Setting (Delivery): Inpatient/Outpatient, Other Community Setting

Program Type: Cognitive Behavioral Treatment, Conflict Resolution/Interpersonal Skills, Family Therapy, Individual Therapy, Parent Training, Victim Programs, Children Exposed to Violence, Violence Prevention

Targeted Population: Victims of Crime, Children Exposed to Violence, Families

Current Program Status: Active

Listed by Other Directories: Child Exposure to Violence Evidence Based Guide

Program Developer:
David J. Kolko
Professor of Psychiatry, Psychology, and Pediatrics; Director, Special Services Unit
University of Pittsburgh School of Medicine; Western Psychiatric Institute and Clinic
WPIC, 3811 O’Hara Street
Pittsburgh PA 15213
Phone: 412.246.5888
Fax: 412.246.5341
Website
Email

Researcher:
David J. Kolko
Professor of Psychiatry, Psychology, and Pediatrics; Director, Special Services Unit
University of Pittsburgh School of Medicine; Western Psychiatric Institute and Clinic
WPIC, 3811 O’Hara Street
Pittsburgh PA 15213
Phone: 412.246.5888
Fax: 412.246.5341
Website
Email