Topic: Child Abuse, Parenting, Behavioral Problems, Trauma
Target Population: Families
Sector: Community-Based
This program is for parents/caregivers and children who are 5 to 17 years old and who are experiencing, or who are at risk for experiencing, family conflict.
Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT), a community-based family-treatment intervention, is designed to address persistent family conflict, defiant behavior, verbal and/or physical hostility, severe discipline, and/or child abuse and intends to strengthen caregiver-child relationships.
A randomized trial was conducted in which families who were at risk of or had a history of child physical abuse were assigned to AF-CBT or treatment as usual (TAU). Families in both conditions were involved in either the child welfare system (CWS) or the mental health system (MHS). Measures were assessed at baseline, 6, 12, and 18 months after baseline. Results indicated that, compared to TAU, AF-CBT cases in CWS had greater achievement of aggression management goals; AF-CBT cases in MHS had greater improvements in child functioning and decreased physical-abuse risk; AF-CBT cases in MHS and CWS had fewer reports of abuse. There were no effects on positive parenting or parental anger.
AF-CBT intends to improve positive parenting practices, cultivate a safe and healthy family environment, strengthen children’s coping and social skills, decrease coercive and aggressive behaviors, reduce the risk of child abuse, and promote child security and prosperity. To accomplish these objectives, the program focuses on emotion regulation, behavior management, problem-solving, social skills, communication, cognitive reframing, and clarification.
These topics are covered throughout the course of the intervention's three phases of treatment:
The intervention includes role-plays, handouts, skill practice and feedback, and homework exercises. Caregivers and children participate in individual and family therapy sessions. The delivery of these sessions is flexible, which allows the therapist to accommodate the needs of the individual and the family.
Since its inception in 1985, the intervention has been implemented with ethnically diverse families in inpatient, outpatient, home, and community settings located in rural, urban, and inner-city areas in the United States and Japan.
Facilitators must be licensed practitioners who hold a master's degree in a mental health field and who work with at-risk families. On-site, off-site, and virtual training options are available. Please use details in the Contact section to obtain more information on training and costs.
Considerations for implementing AF-CBT include securing mental health professionals who are suitably qualified and ensuring they receive training, recruiting participants and obtaining their buy-in, and finding space to hold sessions.
The Clearinghouse can help address these considerations. Please call 1-877-382-9185 or email Clearinghouse@psu.edu
If you are interested in implementing AF-CBT, the Clearinghouse is interested in helping you!
Please call 1-877-382-9185 or email Clearinghouse@psu.edu
AF-CBT is typically provided one to two times a week for a total of 18 to 24 hours of treatment over 6 to 9 months. However, treatment time can be extended as needed.
Implementation costs for AF-CBT vary by therapist. Standard billing rates depend on insurance reimbursement and therapists’ hourly rates.
To move AF-CBT to the Effective category on the Clearinghouse Continuum of Evidence, at least two additional studies with a strong design must be conducted that demonstrate sustained, positive outcomes. At least one of these studies must be conducted independently of the program developer.
The Clearinghouse can help you develop an evaluation plan to ensure the program components are meeting your goals. Please call 1-877-382-9185 or email Clearinghouse@psu.edu
Contact the Clearinghouse with any questions regarding this program.
Phone: 1-877-382-9185 Email: Clearinghouse@psu.edu
You may also contact AF-CBT by visiting https://pitt.co1.qualtrics.com/jfe/form/SV_5zfOzirBUzZZAmF
Kolko, D. J., Herschell, A. D., Baumann, B. L., Hart, J. A., & Wisniewski, S. R. (2018). AF-CBT for families experiencing physical aggression or abuse served by the mental health or child welfare system: An effectiveness trial. Child Maltreatment, 23(4), 319-333. https://doi.org/10.1177/1077559518781068
Herschell, A. D., Quetsch, L. B., & Kolko, D. J. (2020). Measuring adherence to key teaching techniques in an evidence-based treatment: A comparison of caregiver, therapist, and behavior observation ratings. Journal of Emotional and Behavioral Disorders, 28(2), 92-103. https://doi.org/10.1177/1063426618821901
Herschell, A. D., Taber-Thomas, S. M., Kolko, D. J., McLeod, B. D., & Jackson, C. B. (2020). Treatment-as-usual for child physical abuse in community mental health centers: Therapist characteristics, client profiles, and therapy processes. Journal of Emotional and Behavioral Disorders, 28(4), 223-234. https://doi.org/10.1177/1063426619866188
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(4), 322-342. https://doi.org/10.1177/1077559596001004004
Kolko, D. J., Baumann, B. L., Herschell, A. D., Hart, J. A., Holden, E. A., & Wisniewski, S. R. (2012). Implementation of AF-CBT by community practitioners serving child welfare and mental health: A randomized trial: Disseminating child maltreatment interventions: Research and implementing evidence-based programs. Child Maltreatment, 17(1), 32-46.
Kolko, D. J., Iselin, A. R., & Gully, K. J. (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(2), 105-116. https://doi.org/10.1016/j.chiabu.2010.09.004
McGuier, E. A., Rothenberger, S. D., Friedman, A., & Kolko, D. J. (2021). An equivalence analysis of provider education in youth mental health care. Health Services Research, 56(3), 440-452. https://doi.org/10.1111/1475-6773.13659
Quetsch, L. B., Herschell, A. D., Kolko, D., Liebsack, B. K., & Carroll, R. A. (2022). Testing a community developed training protocol for an evidence-based treatment. Evaluation and Program Planning, 92, 102055. https://doi.org/10.1016/j.evalprogplan.2022.102055
