Individual Cognitive Behavioral Treatment and Family Therapy for Physically Abused Children and their Offending Parents: A Comparison of Clinical Outcomes

“System-level linkages require quality review to ensure appropriate referrals, application of evidencebased clinical care, and retraining of mental health specialists (e.g., Cohen and Mannarino, 1998; Deblinger et al., 1996; Kolko, 1996; Kolko and Swenson, 2002; Putnam, 2003; Saunders et al., 2003).”

“…et al., 1996; attention control: Fantuzzo et al., 2005; CBT: Jaberghaderi et al., 2004; case management: Lieberman et al., 2005), or (b) they were developed and evaluated to serve as comparison treatment conditions against primary experimental treatments (CCT: Cohen et al., 2004; FT: Kolko, 1996).”

“…(Breslau et al., 1991; Burton et al., 1994; Wyman et al., 1992); parental homicide (Burman and Allen-Meares, 1994), physical abuse (Anthony, 1986; Kolko, 1996), sexual abuse (Cohen and Mannarino, 1996c), serious medical illness such as cancer and severe burns (Armstrong et al., 1994; Butler et…”

“Cognitively based family interventions have been relatively successful (e.g., Kolko, 1996), and researchers have suggested that they can be expected to be useful as a prevention tool (e.g., Azar, 1997).”

“Cognitive behavioural family therapy (Kolko, 1996; Kolko and Swenson, 2002), parent–child interaction therapy (Chaffin et al.”

“Level 2: Probably Efficacious Group CBT with Parent Involvement In the last review by Silverman et al. (2008), two relatively small (N = 44; N = 55) group CBT with parent involvement studies were included (Deblinger, Stauffer, & Steer, 2001; Kolko, 1996, respectively).”

“), adult civilians (Hall, Mullee, & Thompson, 1995), and children (Berliner & Saunders, 1996; Deblinger, Lippmann, & Steer, 1996; Kolko, 1996).”

“, treatments that directly include at least one parent and child) for child maltreatment with promising results (Brunk, Henggeler, & Whelan, 1987; Chaffin et al., 2004; Kolko, 1996; Wesch & Lutzker, 1991).”

“Interestingly, the pre- to post-treatment changes were also similar in magnitude to those reported by Kolko (1996b) for parents and their abused children completing either individual cognitive behavioral treatment or family therapy (CAPI and CBCL scores), even though PCIT does not specifically target parents’ or child…”

“…is a growing research literature testing the efficacy of mental health intervention with these populations (Berliner & Saunders, 1996; Cohen, Berliner, & March, 2000; Cohen & Mannarino, 1996b; Cohen & Mannario, 1998b; Deblinger, Lippmann, & Steer, 1996; Finkelhor & Berliner, 1995; Kolko, 1996c).”

“For example, the greatest reduction in posttraining recidivism, even though the differences were small (Henggeleret al., 1992; Kolko, 1996; Lutzker & Rice, 1987) have incorporated specific parent training components that use modeling, practice and feedback of parenting skills, in addition to traditional parent educati…”

“Evidence base. Kolko (1996a, 1996b) randomly assigned 55 physically abused children between 6‐13 years old to AF-CBT, abuse-focused family therapy, or routine community services.”

“Cognitive behavioural family therapy (Kolko, 1996; Kolko and Swenson, 2002; Rynyon and Deblinger, 2013), parent–child interaction therapy (Chaffin et al., 2004; Hembree-Kigin and McNeil, 1995; Timmer et al., 2005), and multisystemic therapy (Brunk et al., 1987; Henggeler et al., 2009) are…”

“For example, programs that showed the greatest reduction in posttraining recidivism (Kolko, 1996; Lutzker, & Rice, 1987) incorporated specific parent-training components that used modeling, practice, and feedback of parenting skills in addition to traditional parent education.”

“…for a wide variety of traumatized children, including when compared to treatments commonly used in community settings (e.g., Cohen et al., 2005; Kolko, 1996; Lieberman, Van Horn, & Ippen, 2005), it seems justifiable to provide incentives to therapists to learn and provide EBP for appropriate…”

“Where indicated, all family members were invited to address general interactional problems, such as the use of coercion or physical force, or the need for a few basic “house rules” (Kolko, 1996).”

“Research has suggested that co-occurring difficulties are associated with exacerbated negative outcomes and that PTSD is associated with emotional and behavioral problems (Briere & Runtz, 1993; Browne & Finkelhor, 1986; Goodwin, 1988; Kendall-Tackett et al., 1993; Kessler et al., 1995; Kolko, 1996; Lindberg & Distad,…”

“…commonly used to assess outcomes of interventions designed to prevent occurrences or recurrences of child maltreatment (e.g.,Acton & During, 1992; Haskett, Scott, & Fann, 1995; Kolko, 1996; Meezan & O’Keefe, 1998; Milner, Murphy, Valle, & Tolliver, 1998; Wolfe, Edwards, Manion, & Koverola, 1988).”

“However, recently developed cognitive behavioral models for child physical abuse provide interventions to both parents and children (Kolko, 1996; Kolko & Swenson, 2002; Runyon et al., 2004).”

“Various psychological sequelae have been associated with child physical and sexual abuse including, but not limited to, depressive disorders (Browne & Finkelhor, 1986; Cerezo-Jimenez & Frias, 1994; Kashani & Carlson, 1987; Kolko, 1996; Pelcovitz et al., 1994; D. A. Wolfe, Sas, & Wekerle, 1994), posttraumatic stress di…”

“…Deblinger, Steer, & Lippman, 1999; Feather & Ronan, 2006; Giannopoulou, Dikaiakou, & Yule, 2006; Jaberghaderi, Greenwald, Rubin, Zand, and Dalatabadi, 2004; Kazak et al., 2004; King et al., 2000; Kolko, 1996; March, Amaya-Jackson, Murray, & Schulte, 1998; Smith et al., 2007; Stein et al., 2003).”

“In comparison to Kolko's Alternatives for Families model (AF-CBT; Kolko, 1996; Kolko & Swenson, 2002), an existing Evidence-Based Practice (EBP) for physically abusive families, CPC-CBT specifically includes child PTSD as one of its primary treatment targets.”

“Other studies used cognitive restructuring to target punitive parents’ misinterpretation of children’s behavior, negative attributional biases in assigning causality to child behavior, and unrealistic expectations of the child (see Azar, 1989; Kolko, 1996a).”

“First, although all of the studies noted above (Cohen & Mannarino, 1996a, 1998a, 2000; Kolko, 1996; Lanktree & Briere, 1995) included substantial proportions of minority children, they were probably all insufficiently powered to detect small to medium effect sizes.”

“The CBCL has excellent psychometric properties (reliability, concurrent and treatment validity) and has been used in several treatment outcome studies in child welfare (Cohen et al., 2004; Kolko, 1996a).”

“, parent–child interaction therapy), beliefs, cognitions (Abuse-Focused Cognitive Behaviour Therapy; Kolko, 1996), and maternal sensitivity (e.”

“[21] 2013 84 1 ACT-Parents Raising Safe Kids RCT R Kolko [53] 1996 27–30 56 Cognitive Behavioral Therapy/Family Therapy RCT M Lachman et al.”

“…consisted of seven modules found to be efficacious in prior outcome studies of childhood disruptive behavior disorders (Kolko 1995; Kolko et al. 1990), childhood fire-setting (Kolko 2001), and working with aggressive/abusive families (Kolko 1996a, b; Kolko and Swenson 2002; Kolko et al. 2011).”

“The Child Abuse Incident Report (CAIR; Kolko, 1996b ) is a set of questions in which the caregivers described a specific incident of child abuse.”

“Family therapy: results The following results are these reported by Kolko.(107,108)”

“…oriented behavioral therapies examined in the few randomized controlled trials that have been conducted have consistently demonstrated improved outcomes in parents referred for child physical abuse (Chaffin et al., 2004; Kolko, 1996; Swenson, Schaeffer, Henggeler, Faldowski, & Mayhew, 2010).”

“CBT interventions have been successful with maltreating parents (Azar & Twentyman, 1984; Kolko, 1996) and clinical populations at risk of childhood injury [e.g., parents of aggressive youth (Stern & Azar, 1998) and disruptive childhood disorders (Johnston, 1996)].”

“Kolko (1996) worked with the entire family to promote identification and reduction of coercive behaviors and to replace them with constructive problem solving and positive communication skills.”

“To date, there is one randomized controlled trial (Kolko, 1996 ) and one small pilot study (Runyon et al, 2009 ) that examine the impact of CBT models that directly address the needs of both the at-risk parent who engages in coercive/abusive parenting and the traumatized child.”

“…family functioning were selected based on (a) existing CPS procedures (DePanfilis, 1996; Holder & Corey, 1986), (b) studies of the clinical characteristics and treatment of abused children (e.g., Berliner & Saunders, 1996; Kolko, 1996b), and (c) a concern to incorporate child and parent reports.”

“…physical and sexual abuse provide some therapeutic directions (see Becker et al., 1995; Cohen & Mannarino, 1996; Deblinger, Lippman, & Steer, 1996; Kolko, 1996a; National Academy of Sciences, 1993), but they have examined a small and unrepresentative sample of the clients receiving CPS services,…”

“ren’s externalizing problems, child-to-parent violence, parental distress and abuse risk, and family conflict and cohesion.(34) AF-CBT has been used clinically with urban African American families and has been reviewed by African American stakeholders”

“Key features of protocols found in the latest EBTs and PPs have an important history and foundation in the child trauma literature dating back to the 1980s and 90s (see Berliner & Saunders, 1996; Cohen & Mannerino, 1996; Deblinger, Lippmann, & Steer, 1996; Friedrich, 1996; Gil, 1991; James, 1994; Kolko, 1996; Layne, S…”

“Empirical support for AF-CBT has been found in studies of families presenting with child physical abuse (Kolko, 1996a, 1996b; Kolko, et al., 2011) and child behavior disorders (Kolko, Campo, Kelleher, & Cheng, 2010; Kolko, Dorn, et al., 2009).”

“For example, positive effects have been found in testing a therapeutic day treatment for pre-schoolers who had been abused and neglected (Culp, Richardson, & Heide, 1987); in a trial of peer-initiated social interactions for maltreated pre-schoolers (Fantuzzo, 1990; Fantuzzo, Jurecic, Stovall, Hightower, Goins, & Scha…”

“Cognitive enhancements to interventions with maltreating abusive parents (Azar, 1989; Kolko, 1996) and prevention programs with at-risk parents have shown some effectiveness (Bugental et al.”

“Sample sizes in the three studies ranged from 55 (Kolko 1996) to 212 (McCurdy 2005), with the smallest sample considering the effect of three different interventions.”

“For children who have experienced single-event trauma (March, AmayaJackson, Murray, & Schulte, 1998; Saigh, Yule, & Inamdar, 1996) or sexual abuse (Deblinger, Steer, & Lippman, 1999; Kolko, 1996), cognitive-behavioral therapy (CBT) is the one intervention with empirical support.”

“…abuse-specific cognitive-behavioral treatment procedures for use with child victims have CHILD MALTREATMENT / NOVEMBER 2003 reported gains on related child outcome measures with sexually or physically abused children (Cohen & Mannarino, 1998; Deblinger et al., 1996; Kolko, 1996a, 1996b).”

“Specifically, the means and standard deviations of the cognitive behavioral therapy (CBT) groups (Kolko 1996; Kolko 2012) and the combined cognitive counseling and skills training group (Gormally, Varvil-Weld, Raphael, & Sipps, 1981) were used in the effect size calculations.”

“Some research has indeed indicated that involving family members in treatment may reduce treatment attrition and improve therapy effectiveness (e.g., Dowell & Ogles, 2010; Kolko, 1996; Stupak, Hook, & Hall, 2007).”

“Family therapy was found to be equally effective as CBT, with both of these treatments being superior to community treatment as usual in decreasing children’s externalizing and violent behaviors, in one randomized clinical trial for physically abused children (Kolko, 1996).”

“A number of evidence-based interventions have been developed for use with maltreated children (e.g., Cohen, Deblinger, Mannarino, & Steer, 2004; Kolko, 1996; see Ruggiero, Morris, & Scotti, 2001).”

“In this article, we examine data on cognitions among parents who had participated in a treatment study for CPA (Kolko, 1996).”

“Cognitive‐behavioral interventions have been developed for children who have been victims of sexual abuse (Cohen & Mannarino, 1993; Deblinger & Heflin, 1996), physical abuse ( Kolko, 1996 ), domestic violence (Silvern, Karyl, & Landis, 1995), and single-episode traumas (March et al., 1998).”

“Kolko (1996) found that compared to routine community interventions, children who were physically abused, along with the offending parent, benefited similarly from either both the parent and child receiving individual cognitive behavior therapy or family therapy.”

“There are a number of successful treatment approaches for families in which physical abuse has occurred (see Kolko & Swenson, 2002), but high dropout rates, poor skills acquisition, lack of generalization of treatment effects, and recidivism continue to be a challenge (e.g., Becker et al., 1995; Corcoran, 2000; Kolko,…”

“With regards to the intervention procedures, three of nine studies used individual psychotherapy (Kolko, 1996; Kolko et al., 2011; Swenson et al., 2010); four used group psychotherapy (Kjellgren et al.”

“As far as approaches are concerned, Kolko (1996) contrasted cognitive behavioral treatment with family therapy against a community care control group.”

“To extend Kolko’s [ 49 ] work, efficacy studies are needed that combine parent training and child cognitivebehavioral therapy with clarification, a process designed to address the maladaptive abuse-specific cognitions experienced by CPA victims [74,75,76].”

“In a study comparing AF-CBT, family therapy, and routine community services with physically abused children and their parents and/or families, CBT and family therapy were found to produce superior results to routine care (Kolko, 1996b).”

“These studies have demonstrated equivocal results, with some showing reductions in maltreatment rates (Cameron & Birnie-Lefcovitch, 2000; Gaudin, Wodarksi, Arkinson, & Avery, 1990–1991; Kolko, 1996) and others finding no differences in outcomes (Chaffin, Bonner, & Hill, 2001; Lovell & Richey, 1997).”