Treatment of Child Physical Abuse: Effectiveness Trial

描述（由申请人提供）：根据RFA PA-02-131，题为“心理健康的传播和实施研究”，提交此修订后的申请。儿童身体虐待既常见又与严重的社会心理和健康问题有关。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。在这个应用中，我们建议评估一种针对CPA的干预措施的有效性，这种干预措施最近被描述为以虐待为中心的认知行为疗法（AF-CBT; Kolko & Swenson, 2002），已被确定为值得推广的“最佳实践”（犯罪受害者办公室，国家儿童创伤压力网络；考夫曼基金会项目）。AF-CBT整合了互补的个人和家庭CBT协议，其材料最近被社区从业者改编，以促进可移植性和有效的应用。来自两个县的七个社区机构的从业者将被随机分配到两种干预条件之一：1)AF-CBT（6个机构）或2)照常治疗（TAU； 3个机构）。我们的样本量为100名从业人员和333个家庭，这些家庭在过去6个月内至少有一名符合条件的身体虐待肇事者，并且经常与受虐待的儿童（5-15岁）接触。治疗的持续时间可能会有所不同，但通常会持续大约三到六个月。治疗依从性将通过研究人员对会议录音带的观察和主管和从业人员的自我报告进行评估。四个时间点的数据收集将用于评估两组有效性结果：1)AF-CBT培训对从业者技能/实践的影响（培训前评估、培训后评估、1年和2年随访），以及2)AF-CBT对客户（儿童、父母、家庭）心理健康功能和再滥用率的影响（治疗前评估、治疗后评估、1年和2年随访）。客户有效性部分将在从业者培训完成后开始。其他分析试图确定医生依从性和采用AF-CBT的预测因素，以及通过随访患者的改善。这项研究将提供初步数据，说明在社区环境中为儿童福利系统服务的电子商务服务的可移植性和采用情况。

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.