Treatment of Child Physical Abuse: Effectiveness Trial

描述（由申请人提供）：此修订后的申请是为了响应RFA PA-02-131，题为“精神卫生的传播和实施研究”而提交的。儿童身体虐待（CPA）是常见的，并与重大的心理和健康问题。随着一些有希望的干预措施的出现，这一人群，努力运输经验为基础的治疗（EBT）到社区设置得到了大力鼓励。在本申请中，我们建议评估CPA的一种干预措施的有效性，最近被描述为以虐待为中心的认知行为疗法（AF-CBT; Kolko & Swenson，2002），已被确定为值得传播的“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，其材料最近已被社区从业人员改编，以促进可移植性和有效应用。来自两个县的七个社区机构的从业人员将被随机分配到两种干预条件之一：1）AF-CBT（6个机构），或2）常规治疗（TAU; 3个机构）。我们的项目样本量为100名从业者和333个家庭，在过去6个月内至少有一名符合条件的身体虐待者，并且经常与受虐儿童（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以及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价两组有效性结果：1）AF-CBT培训对从业人员技能/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对客户的影响（儿童、父母、家庭）心理健康功能和再滥用率（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人员培训完成后开始。其他分析旨在确定从业者依从性和AF-CBT采用的预测因素，以及通过随访的客户改善。这项研究将提供在社区环境中为儿童福利系统服务的EBT的可移植性和采用的初步数据。

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.