Treatment of Child Physical Abuse: An Effectiveness Trial

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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.