Program Profile: Alternatives for Families: Cognitive Behavioral Therapy

This is a family therapy program designed to reduce the effects of child abuse. The program is rated Promising. There were statistically significant reductions in family conflict, parent-child violence, physical punishment, and child abuse risk, and improvements in discipline, cohesion, and child acceptance. There were also statistically significant reductions in child internalizing and externalizing symptoms. However, there were no significant differences between groups in re-abuse rates.

A Promising rating implies that implementing the program may result in the intended outcome(s).

A Promising rating implies that implementing the program may result in the intended outcome(s).

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.

Study

Kolko (1996) randomly assigned 55 maltreated children and their guardians to either 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 based on the results of a risk assessment interview. This CrimeSolutions review focused on the comparisons between the CBT group and the RCS control group.

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 similar treatment program, were interested and willing to participate in therapy, and resided locally.

Forty-seven families (one child and one parent) completed the treatment and both the pretreatment and posttreatment assessments. Among the children, the mean age was 8.6 years, and 34 were boys. Forty-seven percent were Black, 47 percent were white, and 3 percent were biracial. Of these children, 68 percent lived with their biological mothers. Additionally, 61 percent of the children met the criteria for an Axis I psychiatric diagnosis (e.g., mood, eating or substance abuse disorders) with two meeting criteria for posttraumatic stress disorder (PTSD). Forty-two of the parents were biological parents, 70 percent had a high school education or less, and 61 percent received medical assistance or welfare. Thirty-four percent of the mothers and 32 percent of the fathers had a lifetime history of drug and alcohol problems, with 35 percent reporting crack cocaine and 67 percent reporting alcohol as the most frequently used substances. Of the parents, 79 percent were mothers who had committed abuse incidents of mild to moderate severity, 86 percent reported that these incidents happened more than once, and 78 percent reported that the incident(s) happened within the month prior to the pretreatment assessment. Forty-one of the parents who participated in the treatment were the alleged persons who committed the abuse. The only statistically significant difference between groups was in racial background. There was a higher proportion of Black participants in the RCS group (80 percent), compared with the CBT group (60 percent). However, as racial background was significantly related to only five outcome variables, it was not incorporated in planned treatment condition comparisons.

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.

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. More information can be found at the program’s website: http://www.afcbt.org/

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

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

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.

Following are CrimeSolutions-rated programs that are related to this practice:

Preventive Child Maltreatment Programs

Preventive child maltreatment programs are designed to prevent physical child abuse or neglect by educating expectant and new parents in parenting skills, coping with stressors, and stimulating child development. This practice is rated Effective for preventing child abuse, neglect, and maltreatment.

Evidence Ratings for Outcomes

Victimization - Child abuse/neglect/maltreatment

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?