Treatment of Child Physical Abuse: Effectiveness Trial

描述(由申请人提供)：本修订申请是针对RFA PA-02-131，题为“精神健康传播和实施研究”而提交的。儿童身体虐待(CPA)很常见，并与严重的心理社会和健康问题有关。随着针对这一人群的一些有希望的干预措施的出现，大力鼓励将基于经验的治疗(EBT)转移到社区环境中。在这项申请中，我们建议评估最近被描述为以虐待为重点的认知-行为治疗(AF-CBT；Kolko&Swenson，2002)的一项针对CPA的干预措施的有效性，该干预已被确定为值得推广的“最佳做法”(犯罪受害者办公室，国家儿童创伤应激网络；考夫曼基金会项目)。AF-CBT整合了互补的个人和家庭CBT方案，其材料最近已被社区从业者改编，以促进可移植性和高效应用。来自两个县的七个社区机构的从业者将被随机分为两种干预条件之一：1)房颤-CBT(6家机构)，或2)照常治疗(TAU；3家机构)。我们预测了100名从业人员和333个家庭的样本规模，其中至少有一名合格的身体虐待犯罪者在过去6个月内，并与被虐待儿童(5-15岁)有定期接触。治疗的持续时间可能有所不同，但一般会持续大约三到六个月。将使用研究人员对会议录音带的观察以及主管和从业者的自我报告来评估治疗依从性。四个时间点的数据收集将用于评估两组有效性结果：1)房颤-CBT培训对从业者剧目/做法的影响(培训前评估、培训后评估、1年和2年跟踪)；以及2)房颤-CBT对受试者(儿童、父母、家庭)心理健康功能和再虐待率的影响(治疗前评估、治疗后评估、1年和2年跟踪)。客户效力部分将在从业者培训完成后开始。其他分析试图确定从业者遵守和采用房颤-CBT的预测因素，以及通过随访改善客户的情况。这项研究将提供关于EBTS在服务于儿童福利系统的社区环境中的可转移性和采用率的初步数据。

DESCRIPTION (provided by applicant): This revised application is being submitted in response to RFA PA-02-131, entitled "Dissemination and Implementation Research in Mental Health". Child physical abuse (CPA) is both common and associated with significant psychosocial and health problems. With the emergence of a few promising interventions for this population, efforts to transport empirically based treatments (EBT) to community settings have been strongly encouraged. In this application, we propose to evaluate the effectiveness of one intervention for CPA, recently described as Abuse-Focused Cognitive-Behavioral Therapy (AF-CBT; Kolko & Swenson, 2002), that has been identified as a "best practice" worthy of dissemination (Office of Victims of Crime, National Child Traumatic Stress Network; Kauffman Foundation Project). AF-CBT integrates complementary individual and family CBT protocols whose materials have recently been adapted by community practitioners to facilitate transportability and efficient application. Practitioners from seven community agencies in two counties will be randomized to one of two intervention conditions: 1) AF-CBT (6 agencies), or 2) Treatment-as-usual (TAU; 3 agencies). We project sample sizes of 100 practitioners and 333 families with at least one eligible perpetrator of physical abuse within the past 6 months and who is in regular contact with the abused child (aged 5-15 years). Treatment may vary in duration but generally will last approximately three to six months. Treatment adherence will be assessed using research staff observations of session audiotapes and self-reports from both supervisors and practitioners. Data collection across four timepoints will be directed towards the evaluation of two sets of effectiveness outcomes: 1) the impact of training in AF-CBT on practitioner repertoire/practices (pre-training assessment, post-training assessment, 1-year and 2-year follow-ups), and 2) the impact of AF-CBT on client (child, parent, family) mental health functioning and reabuse rates (pre-treatment assessment, post-treatment assessment, 1-year and 2-year follow-ups). The client effectiveness component will begin after practitioner training has been completed. Additional analyses seek to identify predictors of both practitioner adherence and adoption of AF-CBT, and client improvement through follow-up. This study will provide initial data on the transportability and adoption of EBTs in community settings serving the child welfare system.