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Status of Research on AF-CBT
Over the past four decades, many of the procedures incorporated in AF-CBT have been found effective by other investigators in improving child, parent, and/or family functioning and reducing abuse risk or re-abuse among diverse populations of parents, children, and families. In a clinical trial that examined both clinical and child welfare outcomes through 1-year follow-up, the two main interventions that have now been integrated in AF-CBT (i.e. individual child and parent CBT and family therapy) were evaluated separately and compared to a condition representing usual care (i.e. cases receiving routine services in other community agencies). Weekly ratings of parents’ use of physical discipline/force and their level of anger problems during treatment decreased for the two AF-CBT interventions, but the decline was significantly faster for individual CBT than for family therapy (Kolko, 1996a).
Compared to routine community services, the individual CBT and family therapy interventions were also associated with significantly greater improvements in child (e.g. less child-to-parent aggression, fewer child externalizing behaviors), caregiver (e.g. decreased child abuse potential, improvement in individual treatment targets reflecting abusive behavior, less psychological distress), and family outcomes (e.g. less conflict and more cohesion), which were generally maintained at follow-up (Kolko, 1996b). Official records revealed abuse recidivism rates of 5% and 6% for the individual CBT and family therapy conditions, respectively. For those receiving routine services, the abuse recidivism rates were 30%. Both CBT and family therapy had high rates of treatment fidelity, session attendance, and consumer satisfaction.
Two recent outcome studies also found benefits from the application of key AF-CBT content incorporated in several treatment modules with families of young children who were clinically referred for significant behavioral disorders or problems. Instead of including a focus on an abusive experience, the content examined caregiver’s use of physical punishment/discipline and family exposure to aggression/coercion, where relevant. One study with 144 children (ages 6 – 11) who were diagnosed with Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD) found that the modular intervention was equally effective in reducing behavioral dysfunction at 3-year follow-up when applied in a community or clinic setting (Kolko, Dorn, et al., 2009).
A second study reviewed 163 children with behavior-problems that were recruited in pediatrician offices. It compared on-site, nurse-administered intervention to enhanced usual care that included assessment recommendations and a facilitated referral to a community provider. The on-site intervention was associated with significantly greater service use, had higher treatment completion rates, fewer service barriers, more consumer satisfaction, and showed greater improvements on key clinical outcomes (e.g., remission for disruptive behavioral disorders) at one year follow-up (Kolko, Campo, & Cheng, 2010).