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

“Using this measure as a guide, an adherence measure specific to AF-CBT (Kolko, 1996) and from a previous efficacy trial (Kolko et al., 2012), as well as referencing the CBT manual as a starting point for key treatment components, the present researchers created items to assess core components of…”

“The CBCL has good psychometric properties (reliability, concurrent and treatment validity) and has been used in several treatment-outcome studies in child welfare (Kolko, 1996).”

“…in treatment outcome research with maltreated children, and empirical support has been accumulating for various cognitive-behavioral interventions (Cohen, Deblinger, & Mannarino, in press; Cohen & Mannarino, 1996, 1998; Deblinger & Heflin, 1996; Deblinger, Lippmann, & Steer, 1996; Kolko, 1996).”

“…treatment designed to meet the needs of both the child and caregiver such as Alternatives For Families Cognitive Behavioral Therapy (AF-CBT; Kolko 1996), Combined Parent-Child Cognitive Behavioral Therapy (CPC-CBT; Runyon and Deblinger 2014), PCIT (Eyberg and Funderburk 2011), or SafeCare…”

“%) service use (Poertner, McDonald, & Murray, 2000) and low rates after EBT (Chaffin et al., 2004; Kolko, 1996a).”

“Although this study was not as methodologically rigorous as a randomized clinical trial, it was able to demonstrate several outcomes associated with the receipt of AF-CBTwhen evaluated in the context of the “unique” content of four other EBTs in a child protection treatment setting [44].”

“Various aspects of CAC services have been studied, including forensic interviews (Jones, Cross, Walsh, & Simone, 2007) and medical exams (Walsh, Cross, Jones, Simone, & Kolko, 2007). The forensic interview has been the focal point of CAC services since the inception of CACs, and Jones and colleagues (2007) found that…”

“…and Content Each protocol consisted of seven modular components that were based on recommendations and materials found in our prior treatment programs for behavior disorders (Kolko et al. 2010) and aggressive families (Kolko 1996; Kolko and Swenson 2002), as well as other sources (Kazdin 2011).”

“AF-CBT has been found to improve functioning in school-age children, their parents (caregivers), and their families (Kolko, 1996a, 1996b).”

“…Ratings (IGARAcute) Parents completed an interview in which they identified and then rated up to five individualized child problem behaviors to be targeted by treatment using an Individualized Goal Achievement Ratings (IGAR) form which was adapted from our prior outcome studies (Kolko 1996, 2001).”

“Treatment models include various forms of play therapy (Gil 1991; Jernberg 1979; Terr 1983), cognitive-behavioral approaches (e.g., Cohen and Mannarino 1998; Deblinger and Heflin 1996; Kolko 1996 ), group therapy (Berliner and Saunders 1996), and family therapy (Kolko and Swenson 2002).”

“Two evidence-based trauma therapies are used: (a) trauma-focused cognitive behavioral therapy (TF–CBT; J. A. Cohen & Mannarino, 1997; Deblinger, Lippmann, & Steer, 1996) and (b) abuse-focused cognitive behavioral therapy (AF–CBT; Kolko, 1996).”

“It teaches self-control skills, relaxation methods, and social skills to children (Kolko, 1996) and uses psychoeducational methods to influence parents on violence, corporal punishment, and attributions regarding child behavior.”

“…have been integrated into intervention with maltreating parents and prevention efforts with at-risk parents (Azar, 1989, 1993; Azar et al., 1984; Bugental et al., 2002; Kolko, 1996; Sanders, 1999; Stern & Azar, 1998; see Azar, Nix, & Makin Byrd, 2005, for a discussion of such techniques).”

“Youth receiving CBT showed continued improvements at 1-year follow-up, whereas youth receiving the comparison conditions showed no change (Cohen & Mannarino, 1997; Kolko, 1996 ).”

“For example, in light of our finding that children who experience abuse were more likely to be among the most expensive users, high quality evidencebased interventions, and such as cognitive behavior therapy (Cohen et al. 2003; Kolko 1996) should be provided for these children.”

“Therefore, positive changes in children’s behavior could become evident in further follow-up evaluations (as observed by Borrego, Urquiza, Rasmussen, & Zebell, 1999; Kolko, 1996; Nicholson et al., 2002; Swenson et al., 2010).”

“, 1994; Lanktree & Briere, 1995; Stauffer & Deblinger, 1996) and child behavior problems in physically abused children (Kolko, 1996a).”

“A trained research assistant (unaware of implementation condition) will rate recordings using the Treatment Integrity Rating Form [139].”

“…children have shown positive improvements following trauma-focused cognitive behavioral therapy (TF–CBT) and abuse-focused cognitive behavioral therapy (AF–CBT; e.g., Cohen, Deblinger, Mannarino, & Steer, 2004; Cohen, Mannarino, & Knudsen, 2005; Deblinger, Stauffer, & Steer, 2001; Kolko, 1996).”

“…risk instruments are commonly used to assess outcomes of interventions designed to prevent further recurrences of child maltreatment (e.g., Acton and During 1992; GershaterMolko et al. 2003; Haskett et al. 1995; Kolko 1996; Lounds et al. 2004; Meezan and O’Keefe 1998; Milner et al. 1998).”

“ies (Kolko, 1996; Kolko et al., 2009, 2010), it is possible 0 2 4 6 8 10 12 14 16 18 20”

“Several high-quality randomized controlled trials (RCTs) have demonstrated statistically significant and clinically meaningful reduction in trauma symptoms and improvement in functioning following participation in trauma-focused treatments such as Alternatives for Families-CBT (AF-CBT) (Kolko, 1996), Trauma-Focused CB…”

“AF-CBT targets factors at: (1) the parent level, e.g., parental hostility and anger, negative attributions about the child, and ineffective or harsh parenting practices; (2) the child level, e.g., child’s anger, anxiety, trauma-related distress, social interaction skills, behavioral problems, and negative self-attribu…”

“All the previously mentioned studies on parent interventions selected had a cognitive-behavioral approach guiding the intervention, which is the model with the largest empirical support to date for interventions with parents [29, 30].”

“…Kolko, 1995, Kolko & Swenson, 2002) and has been found to be effective for treating children with behavior disorders (Kolko, Loar, & Sturnick, 1990, Kolko et al., 2009), child firesetters (Kolko, 2001), and families with high abuse potential (Kolko, 1996a, 1996b; Kolko, Iselin, & Gully, 2011).”

“Current evidence-based models designed for physically abused youth that incorporate individual and conjoint sessions, such as Alternatives for Families: A Cognitive-Behavioral Therapy, would be useful in addressing these issues (Kolko 1996).”

“, 1992), parental homicide (Burman & Allen-Meares, 1994), sexual abuse (Cohen & Mannarino, 1996), physical abuse (Kolko, 1996), serious medical illness such as cancer and severe burns (Armstrong, Gay, & Levy, 1994; Butler, Rizzi, & Handwerger, 1996; Stoddard, 1996) and war (Garbarino & Kostelny, 1996; Laor 32 H.”

“…studies for behavior disorders (Kolko et al., 2009; Kolko, Loar, & Sturnick, 1990), child firesetters (Kolko, 2001) and aggressive/abusive families (Kolko, 1996a, 1996b; Kolko, Iselin, & Gully, 2011), many of which have now been integrated in Alternatives for Families: A Cognitive-Behavioral…”

“A Cognitive Behavioral Therapy (Kolko, 1996).”

“In four randomized trials, AF-CBT has been shown to reduce caregiver risk factors for physical abuse, family conflict, and children’s externalizing behavior problems (e.g., Kolko, 1996a, 1996b; Kolko, Baumann, Herschell, Hart, & Wisniewski, 2012).”

“Specifically, a better understanding of mothers’ implicit theories about mothering may help developing better intervention strategies for cognitive restructuring, problem-solving training, and reattribution training (e.g., Azar & Wolfe, 2006; Kolko, 1996).”

“AF-CBT, supported by an RCT (Kolko 1996 ), was designed to help families coping with the consequences of physical abuse, violence, harsh or coercive parenting.”

“…trial documented the efficacy of individual CBT and family-systems therapy, and showed that CBT reduced caregiver anger and physical force faster than family-systems therapy on parent- and child-reported anger and family problem ratings completed at the start of each session (Kolko, 1996a, 1996b).”

“Studies have called into question the effectiveness of children's mental health services as generally practiced in the community, despite the fact that many effective treatments have been developed in controlled clinic settings (Kolko, 1996; Weiss, Catron, Harris, & Phung, 1999; Weisz, 2000).”

“Family work with abusive families has started to differentiate between families with physical abuse and neglect, and families where sexual abuse has occurred (Kolko, 1996; Crittenden, 1988; Stratton, 1991; Hanks, 1993).”

“All of the randomized clinical trials conducted studied child abuse as the trauma (Berliner and Saunders 1996; Celano et al. 1996; Cohen and Mannarino 1996; Deblinger et al. 1996; Kolko 1996).”

“An additional family intervention is Physical Abuse-Informed Family Th erapy (Kolko, 1996), which en lists the participation of all family members to enhance co operation and motivation through developing an understanding of coercive behavior, teaching communication skills, and prob lem solving.”

“…harsh or maltreating parenting have focused on cognitions such as cognitive restructuring, problem-solving training, and re-attribution training (Azar & Wolfe, 2006; Bugental et al., 2002; Kolko, 1996; Kolko, Iselin, & Gully, 2011; Sanders, Markie-Dadds, Tully, & Bor, 2000; Sanders et al., 2004).”

“These methods include cognitive behavioral treatment focused on child abuse (17), modifying child-mother interactions”

“Besides treatment for specific symptoms, physically abused children need trauma-focused therapy (17), as studies have proved that abuse-related symptoms decrease when addressed specifically in therapy (23).”

“Researchers have directly linked neglect in early life to attachment problems (Perry, Pollard, Blakely, Baker, & Vigilant, 1995; Kolko, 1996).”

“Although the overall rating for CAPI between group responsiveness met the recommended effect size threshold, it is important to note that the effect was driven from the treatment sample of only two studies (i.e., Hubel et al., 2018; Kolko, 1996).”

“Evidence from three RCTs (Chaffin et al., 2004; Kolko, 1996; Swenson et al., 2010) and one observational study (Schaeffer et al., 2013) suggest family-based therapies may reduce the recurrence of physical abuse or neglect, compared with usual care up to 24-months post-treatment.”

“Findings about the effectiveness of these interventions are beginning to emerge (Berliner & Saunders, 1996; Deblinger, Lippmann, & Steer, 1996; Kolko, 1996).”

“AF-CBT is most appropriate for use with physically, emotionally, and/or verbally abusive or coercive parents and their school-aged children (Kolko, 1996a; Kolko, 1996b).”

“Treating emotionally traumatized children within their primary caregiving systems produces more lasting child and family level benefits and for this reason, family and caregiver-child therapy sessions are incorporated into evidence based treatment models such as Trauma Focused Behavioral Therapy (TF-CBT) and Alternati…”

“The sample size of this study was calculated based on the most similar available article titled: “individual cognitive behavioral treatment and family therapy for physically abused children and their offending parents: A comparison of clinical outcomes” (15).”

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