Afcbt General
Afcbt General
Afcbt General
Clinical & Are you aware of any suggestion/evidence that this treatment may be harmful?
Anecdotal r Yes rx No r Uncertain
Evidence
Extent to which cultural issues have been described in writings about this
intervention (scale of 1-5 where 1=not at all to 5=all the time). 2
This intervention is being used on the basis of anecdotes and personal
communications only (no writings) that suggest its value with this group.
r Yes r x No
Are there any anecdotes describing satisfaction with treatment, drop-out rates
x Yes r No
(e.g., quarterly/annual reports)? r
If YES, please include citation: see articles below
x Yes r No
Has this intervention been presented at scientific meetings? r
If YES, please include citation(s) from last five presentations:
Kolko, D. J., Baumann, B. L., Shaver, M. & Higa, J. (November, 2011). Case
consultation with community practitioners in an effectiveness trial: Description
and evaluation. In R. Beidas (Chair). Consultation, a critical component of
dissemination and implementation of empirically supported treatments. Paper
presented at the 45th Annual Convention of the Association for Behavioral and
Cognitive Therapies, Toronto, Ontario, Canada (11/13)
Kolko, D. J. (2011, August). AF-CBT for DBD: A Modular Approach. In John
Lochman (chair), Innovations for Interventions for Disruptive Behavior Disorders.
Invited paper presented at the 119th annual meeting of the American Psychology
Association, Washington, D.C. (8/4). Taped for CEU credit.
Kolko, D. J. (November, 2011). NCTSN Learning Collaborative to Train Community
Practitioners in AF-CBT. In R. Chase (Chair). Moving out of the ivory tower: The
learning collaborative approach to the implementation of best practices in
community settings. Paper presented at the 45th Annual Convention of the
Association for Behavioral and Cognitive Therapies, Toronto, Ontario, Canada
(11/12)
Kolko, D. J. (November, 2011). AF-CBT consultation in child welfare and mental
health. In S. Decker (Chair). Consultation to improve implementation: How is it
being used and what is working? Paper presented at the 45th Annual Convention
of the Association for Behavioral and Cognitive Therapies, Toronto, Ontario, Canada
(11/12)
Are there any general writings which describe the components of the intervention
x Yes r No
or how to administer it? r
If YES, please include citation: AF-CBT Implementation Guide, v.2.2;
Kolko, 1996a; Kolko, 1996b; Kolko, 2002; Kolko & Swenson, 2002
Pilot Trials/Feasibility N=52 SAMHSA pilot study conducted with Safe and Healthy
Trials (w/o control groups) Families Program, Intermountain Care, Salt Lake City, UT
Child physical
(Kolko et al., 2011)
abuse with other
forms of abuse/
trauma (e.g., 60%
were sexually
abused)
By gender:
52% male; 48%
female
By ethnicity: 89%
Caucasian;
3% Asian; 2%
African-American;
2% Native American;
4% multi-racial
Randomized Controlled N=55 children NCCAN Grant, 1990-1996; Kolko, 1996a; Kolko, 1996b
Trials
By gender:
72% male
By ethnicity: 53%
African-American or
biracial
Outcomes What assessments or measures are used as part of the intervention or for research
purposes, if any?
Agencies and individuals can choose from the assessments listed below based on
target population, outcome targets, and availability of measures.
Caregiver parenting practices and distress/abuse potential
Conflict Tactics ScalesParent to Child version (CTSPC; Straus et al., 1998)
Alabama Parenting Questionnaire (APQ; Shelton et al., 1996)
Parent Perception Inventory (PPI; Hazzard et al., 1983)
Brief Child Abuse Potential Inventory (B-CAP; Ondersma et al., 2008)
Childrens behavioral and emotional problems
Strengths and Difficulties Questionnaire (Bourdon, Goodman, Rae, Simpson &
Koretz, 2005)
Trauma Symptom Checklist for Children (TSCC; Briere, 1996)
Child Posttraumatic Stress Scale (CPSS) or UCLA PTSD Reaction Index (Pynoos
and Steinberg, 2002)
Family functioning, especially levels of conflict and cohesion
Family Environment Scale (FES; Moos et al., 1974)
Outcomes Some of the methods incorporated in AF-CBT have been found efficacious in outcome
continued studies conducted with various populations of parents, children, and families over the
past three decades (see Chalk & King, 1998; Kolko, 2002). The individual and family
approaches in AF-CBT were evaluated relative to routine community services (RCS) in
a clinical trial that evaluated key outcomes through a one-year follow-up assessment.
In an initial analysis comparing the treatment course of the two randomized condi-
tions (individual CBT vs. family therapy; see Kolko, 1996a), weekly ratings of parents
use of physical discipline/force and anger problems were found to decrease signifi-
cantly faster among the individual child and parent CBT cases than those receiving
family treatment, but both showed significant improvements over time.
In terms of overall clinical outcomes through follow-up (Kolko, 1996b), both the indi-
vidual CBT and family therapy conditions reported significantly greater improvements
than RCS on certain child (i.e., less child-to-parent aggression, child externalizing
behavior), parent (i.e., child abuse potential, individual treatment targets reflecting
abusive behavior, psychological distress, drug use), and family outcomes (i.e., less con-
flict, more cohesion.) The official recidivism rates for CBT and family were lower (5-6%)
than the rate for RCS (30%). Both CBT and family therapy had high consumer satisfac-
tion ratings.
A CBT for child physical abuse that includes many of the components currently incor-
porated in AF-CBT was piloted with physically-abused children and their caregivers in
a clinical program (PARTNERS) by Brown (2005). The targets for intervention were: (1)
childrens internalizing symptoms (including posttraumatic stress disorder) and external-
izing behavior problems, (2) caregivers recidivism, (3) childrens cognitive processing
of the abuse, and (4) parenting practices. In an open trial with pre-treatment, mid-
treatment, post-treatment, and 3-month follow-up assessments, we examined whether
mental health problems in children exposed to physical abuse can be reduced through
a 16-week parent- and child-focused cognitive behavioral intervention. Eleven children
(ages 6-12; 73% boys; 82% Latino and 18% African American/Black) and their primary
caregivers participated. Children completed self-report measures of psychopathology,
anger, and attributions about the abuse (e.g., shame, self-blame). Caregivers completed
measures of parenting practice (including corporal punishment), child abuse potential,
and psychopathology. At baseline, all of the children met criteria for a psychiatric disor-
der (APA, 1994), with 45% meeting criteria for two and 18% meeting criteria for three.
The most common diagnoses were: posttraumatic stress disorder, separation anxiety
disorder, and generalized anxiety disorder. Within-subjects repeated measures analyses
indicated significant pre to post decreases in childrens Conduct Problems and Anxiety
(on the Behavioral Assessment System for Children), and Shame. Both children and
their caregivers reported significant decreases in caregivers use of corporal punish-
ment and physical abuse.
We also conducted a study (Kolko, Iselin, & Gully, 2011) that describes the long-term
sustainability and outcome of AF-CBT as delivered by practitioners in a community-
based child protection program who had received training in the model several years
earlier. Formerly described as Abuse-Focused CBT, AF-CBT is an evidence-based treat-
ment (EBT) for child physical abuse and family aggression/conflict that was included in
the National Child Traumatic Stress Networks initial EBT dissemination efforts in 2002.
Training Materials List citations for manuals or protocol descriptions and/or where manuals or
& Requirements protocol descriptions can be obtained.
A recently revised training manual (session guide that includes topical content and
worksheets/handouts) is provided as part of an approved training program in AF-CBT.
Kolko, DJ, Brown, EJ, Shaver, ME, Herschell, AD, & Baumann, BL. Alternatives for
Families: A Cognitive Behavioral Therapy (AF-CBT) Session Guide (3rd edition;
November 1, 2011). Pittsburgh, PA: University of Pittsburgh School of Medicine.
How/where is training obtained?
Interested professionals can request a training through on online form posted on the
AF-CBT website (URL listed below). Training is intended for masters-level mental health
professionals with at least some advanced training in psychotherapy skills/methods
and experience working with conflictual caregivers and their children. Participants
are encouraged to review a brief summary of the treatment approach and the AF-CBT
session guide (topical content and handouts/worksheets) beforehand. We offer training
in the context of a year-long learning community which includes a 3-day intensive skills
training workshop (didactics and experiential exercises), followed by monthly case
consultation calls (often with 2 presenter/call), a booster training/seminar, reviews
of treatment session audio files, and supervisor support calls to facilitate program
implementation of AF-CBT. The duration of consultation may vary by level of experience
and case difficulty (typical range: six to 18 hours over six to twelve months).
What is the cost of training?
The cost for a one-year, learning community in AF-CBT (often configured for up to 15
people per trainer) may vary, as it is based on an individualized training program plan
and depends upon the total number of trainees, booster session modality (on site vs.
videoconference), inclusion of reviews of session audio files, and travel requirements.
Please contact Dr. Kolko to discuss a training program and its cost.
Are intervention materials (handouts) available in other languages?
x Yes r No Spanish and Japanese handouts for families are available; however, the
r
Session Guide is only available in English.
Pros & Cons/ What are the pros of this intervention over others for this specific group
Qualitative Im- (e.g., addresses stigma re. treatment, addresses transportation barriers)?
pressions Comprehensive content for children, parents, and families; focus on family conflict,
aggression, and if applicable alternatives to the use of excessive physical discipline
including child physical abuse; structured session guide with handouts to facilitate
implementation.
What are the cons of this intervention over others for this specific group
(e.g., length of treatment, difficult to get reimbursement)?
Clinicians tailor the material to the needs of the clients, so it requires clinician
decision-making about what content should be emphasized. In addition, the treatment
can at times be lengthy, may involve working with difficult to engage families, and
requires that practitioners draw upon considerable personal and professional
resources.
References Brown, E. J. (2005, June). Efficacy of a parent-child intervention for physically abused children and their
caregivers. Paper presented at the Annual Colloquium of the American Professional Society on the Abuse
of Children, New Orleans, LA.
Kolko, D. J. (1996). Individual cognitive-behavioral treatment and family therapy for physically abused
children and their offending parents: A comparison of clinical outcomes. Child Maltreatment, 1, 322-342.
Kolko, D.J. (1996). Clinical monitoring of treatment course in child physical abuse: Psychometric
characteristics and treatment comparisons. Child Abuse & Neglect, 20, 23-43.
Kolko, D. J. (2002). Child physical abuse. In J.E.B. Myers, L. Berliner, J. Briere, C.T. Hendrix, C. Jenny &
T. Reid (Eds.), APSAC handbook of child maltreatment (2nd Ed., pp. 21-54). Thousand Oaks, CA: Sage
Publications.
Kolko, D. J. & Swenson, C. C. (2002). Assessing and treating physically abused children and their families: A
cognitive behavioral approach. Thousand Oaks, CA: Sage Publications.
Herschell, A. D., Kolko, D. J., Baumann, B.L., & Davis, A.C. (2010). The Role of Therapist Training in the
Implementation of Psychosocial Treatments: A Review and Critique with Recommendations. Clinical
Psychology Review, 30, 448-466.
Kolko, D. J., Iselin, A. M., Gully, K. (2011). Evaluation of the Sustainability and Clinical Outcome of
Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) in a Child Protection Center. Child Abuse &
Neglect, 35, 105-116.
Kolko, DJ, Brown, EJ, Shaver, ME, Herschell, AD, Baumann, BL. Alternatives for Families: A Cognitive
Behavioral Therapy (AF-CBT) Session Guide, third edition. November 1, 2011. Pittsburgh: University of
Pittsburgh School of Medicine.
Kolko DJ, Baumann BL, Herschell, AD, Hart, JA, Holden, EA, Wisniewski, SR. (2012). Implementation of
AF-CBT by community practitioners serving child welfare and mental health: A randomized trial. Child
Maltreatment, 17, 32-46.
Herschell, A. D., Kolko, D. J., Baumann, B. L.., & Brown, E. J. (in press). Alternatives for Families: A Cognitive-
Behavioral Therapy: Applications in the Schools. Psychology in the Schools.