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Abuse-Focused Cognitive Behavioral Therapy for Child Physical Abuse

Series: Issue Briefs

Author(s):   Child Welfare Information Gateway

Year Published:  2007

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You are in section: Table of Contents 1. What Makes AF-CBT Unique 2. Key Components 3. Target Population 4. Effectiveness of AF-CBT 5. What to Look for in a Therapist 6. Conclusion 7. Resources for More Information

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4. Effectiveness of AF-CBT

The effectiveness of AF-CBT is supported by outcome studies, and AF-CBT has been recognized by other experts as a 'model' or 'promising' treatment program.

Demonstrated Effectiveness in Outcome Studies

During the past three decades, many of the procedures incorporated into AF-CBT have been evaluated by outside investigators as effective in:

• Improving child, parent, and/or family functioning
• Reducing abuse risk or re-abuse among various populations of parents, children, and families

These procedures have included the use of stress management and anger-control training, child behavior management training, information regarding appropriate developmental expectations, social skills training, and family interventions focusing on reducing conflict (see Chalk & King, 1998; Kolko, 2002).

The individual child CBT, parent CBT, and family therapy components now integrated in AF-CBT were evaluated separately in a study published in 1996. The CBT components were also compared to a third condition'participation in routine community services'in a clinical trial that evaluated key outcomes through a 1-year follow-up assessment. Findings from this research reflected the following:

• In a comparison of individual CBT and family therapy (two separate randomized conditions), weekly ratings of parents' use of physical discipline/force and anger problems during treatment decreased for both groups, although the decline was significantly faster for the group receiving individual CBT (Kolko, 1996a).
• Groups receiving both individual CBT and family therapy reported greater improvements than routine community services on certain outcomes, including:
• Child outcomes, such as less child-to-parent aggression and fewer child externalizing behaviors
• Parent outcomes, such as decreased child abuse potential, improvement in individual treatment targets reflecting abusive behavior, less psychological distress, and less drug use
• Family outcomes, such as less conflict and more cohesion (Kolko, 1996b)
• Official records for the entire study period revealed lower, yet nonsignificant, rates of recidivism among the adults who participated in individual CBT (5 percent) and family therapy (6 percent), compared to those receiving routine services (30 percent).
• Both CBT and family therapy had high rates of session attendance and high consumer satisfaction ratings.

Key AF-CBT outcomes are summarized in the exhibit below.

Recognition as an Evidence-Based Practice

Based on systematic reviews of available research and evaluation studies, several groups of experts and Federal agencies have highlighted AF-CBT as a model program or promising treatment practice. This program is featured in the following sources:

• Closing the Quality Chasm in Child Abuse Treatment: Identifying and Disseminating Best Practices (Chadwick Center, 2004) www.chadwickcenter.org/Documents/Kaufman%20Report/ChildHosp-NCTAbrochure.pdf (PDF - 2152 KB)
• The National Child Traumatic Stress Network (Empirically Supported Treatments and Promising Practices, supported by the Substance Abuse and Mental Health Services Administration, 2005) www.nctsn.org/nccts/nav.do?pid=ctr_top_trmnt_prom
• Child Physical and Sexual Abuse: Guidelines for Treatment (Saunders, Berliner, & Hanson, Eds., National Crime Victims Research and Treatment Center and The Center for Sexual Assault and Traumatic Stress; Office for Victims of Crime, U.S. Department of Justice, 2004) www.musc.edu/ncvc/resources_prof/OVC_guidelines04-26-04.pdf (PDF - 427 KB)
• The California Evidence-Based Clearinghouse for Child Welfare (2006) www.cachildwelfareclearinghouse.org

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You are in section: Table of Contents 1. What Makes AF-CBT Unique 2. Key Components 3. Target Population 4. Effectiveness of AF-CBT 5. What to Look for in a Therapist 6. Conclusion 7. Resources for More Information

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Updated on March 1, 2010