Assessing and Treating Physically Abused Children and Their Families: A Cognitive-Behavioral Approach
Publication Year: 2002
A professional book aimed at practitioners and practitioners in training, this volume is the first attempt to provide a comprehensive, practical approach to the assessment and treatment of physically abused children. While there are other books that cover certain aspects of assessment and treatment, this book is comprehensive in that it covers child-specific, parent-specific, and family-specific interventions. The volume will present an overview of child physical abuse (including statistics and consequences), it will discuss outcome studies and treatment implications, and it will thoroughly discuss assessment and treatment. It will help practitioners: Understand children’s abuse experiences, views, exposures to violence, and it will help expose thinking errors or negative attributions. It will also help the practitioner help the children with anxiety management, anger management, social skills, ...
- Front Matter
- Back Matter
- Subject Index
- Chapter 1: Introduction and Overview
- Significance of the Problem
- The Challenge before Us
- Purpose and Overview of the Book
- Chapter 2: Characteristics and Correlates of Child Physical Abuse
- Child Characteristics and Correlates
- Maltreating Adult Characteristics and Correlates
- Family-System Characteristics and Correlates
- Community Characteristics and Correlates
- What Causes Child Physical Abuse?
- Chapter 3: Treatment Outcome Studies: Clinical and Research Implications
- What Have We Learned?
- What Do We Need to Learn in Research to Make Treatment More Effective?
- What Would Make Clinical Practice More Effective Now?
- Chapter 4: Conducting a Comprehensive Clinical Assessment
- Assessment Overview
- The Clinical Assessment
- Case Presentation: The Comprehensive Clinical Assessment
- Chapter 5: A Comprehensive Individual and Family Cognitive-Behavioral Therapy (CIF-CBT) Model
- Models of Child Physical Abuse
- The Integration of Child, Parent, and Family Approaches
- Chapter 6: Initial Treatment Considerations
- Preparation and Prerequisites
- Overview of Treatment
- Chapter 7: Treatment of the Child Victim: Understanding the Child's Experiences and Behavior
- Perspectives on the Child's Experiences with Family Hostility and Violence
- Contributors to Coercive or Stressful Interactions
- Understanding How We Respond to Different Problem Situations
- Chapter 8: Treatment of the Child: Cognitive Interventions
- Clarifying and Changing the Child's View of Violence
- Normalization of the Child's Abuse-Related Feelings and Reactions
- Psychoeducation about Physical Abuse
- Chapter 9: Child Treatment: Affect-Focused Interventions
- Affect Identification and Expression
- Management of Stress and Anxiety
- Management of Anger
- Chapter 10: Promoting Children's Effective Coping and Social Competence
- Children's Coping Skills
- Social Support
- Enhancing Children's Social Competence and Developing Relationships: Getting along with Friends and Family
- Chapter 11: Adult Treatment: Cognitive Interventions
- Parental Perspectives on Violence, Expectations, and Distortions
- Stress Management and Family Characteristics
- Views on Hostility and Violence
- Expectations of Our Children
- Thinking in Negative or “Distorted” Ways
- Chapter 12: Treatment of the Maltreating Adult: Affect-Focused Interventions
- Self-Management and Affect Regulation of Abuse-Specific Triggers
- Self-Management and Regulation of Anger
- Self-Management, Regulation of Anxiety, and Posttraumatic Stress Disorder
- Self-Management and Regulation of Depression
- Chapter 13: Treatment of the Maltreating Adult: Behavior Management Techniques
- Parenting and Behavior Management
- Specific Techniques and Guidelines for Rewarding Behavior
- Specific Techniques and Guidelines for Punishing Behavior
- A General Review of Behavior Management
- Chapter 14: From Individual to Family Treatment: Bridging Through Clarification
- The General Structure of Clarification
- The Clarification Family Meeting
- Chapter 15: Family Treatment: Setting the Foundation
- Overview of Treatment
- Setting the Foundation
- Assessment of Family Functions and Interactions
- Chapter 16: Family Treatment: Skills Training and Applications
- Review of Initial Progress
- Family Skills Training
- Family Skills-Training Applications
- Chapter 17: Community and Social System Involvement
- Service Settings and Systems
- Chapter 18: Case Examples and Applications
- Case One: James
- Case Two: Tanisha
- Case Three: Marvin
- Chapter 19: Conclusions
- Summary of Chapter Content
- Final Comments
Copyright © 2002 by Sage Publications, Inc.
All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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Printed in the United States of America
Library of Congress Cataloging-in-Publication Data
Kolko, David J.
Assessing and treating physically abused children and their families: a cognitive-behavioral approach / by David J. Kolko and Cindy Cupit Swanson.
p. cm. — (Interpersonal violence, the practice series)
Includes bibliographical references and index.
ISBN 0-7619-2148-6 (c) 0-7619-2149-4 (p)
1. Abused children. 2. Cognitive therapy. I. Swanson, Cindy Cupit. II. Title. III. Interpersonal violence.
RJ507.A29 K65 2002
This book is printed on acid-free paper.
02 03 04 05 06 7 6 5 4 3 2 1
Acquiring Editor: Margaret H. Seawell
Editorial Assistant: Alicia Carter
Production Editor: Diana E. Axelsen
Copy Editor: Stacey Shimizu
Typesetter/Designer: Doreen Barnes
Indexer: Rachel Rice
Cover Designer: Sandra Ng
In recent years, expanding research in the field of child maltreatment has taken us toward a broader understanding of the problems that abused children may encounter and the potential solutions for those problems. Given that the individual problems and family circumstances associated with child physical maltreatment are so varied and complex, the solutions also must be comprehensive.
In this book, Drs. Kolko and Swenson integrate a large body of research literature with real-world information from clinical practice. To their credit, the authors have carefully described and illustrated an array of procedures that nicely lend themselves to efficient application. The pleasing result is a careful description and thoughtful illustration of ways that practitioners can apply a comprehensive, empirically based model for intervening in cases involving child physical abuse.
Historically, the field of child maltreatment has emphasized individually focused interventions for abusive or at-risk parents or, in some cases, abused or maltreated children. These interventions often vary considerably in the extent to which they are based on empirical evidence of their efficacy. Surprisingly, the field has held to individually focused interventions for the most part, even though the occurrence of physical abuse relates to certain factors within the child, parent, family, and community domains. Kolko and Swenson present one of the few integrated models that appreciate the empirically based, individually [Page x]focused interventions, while at the same time taking us a step further through the incorporation of family-systems interventions.
Throughout the volume, Kolko and Swenson cite evidence for the efficacy of various techniques designed to address an array of child, adult, and family concerns. Readers are provided with extensive knowledge of general physical abuse information and an understanding of why and how the techniques may be useful. These empirically validated techniques are illustrated through concrete examples, transcripts, and case description to maximize clinical intervention and equip the reader to put research into practice. Beyond description of the precise application of these techniques is the strong implication that professional systems (i.e., the court and child protection) and the family's greater ecology are important partners in the treatment process.
This book is especially important given the recent focus by health care programs on both clinician accountability and the measurement of client outcomes. Because child physical abuse is not a diagnosis but can lead to a variety of mental health problems, an efficient assessment that articulates both specific strengths and weaknesses is essential to the effective resolution of problem behaviors and reduction of further risk. The model illustrated in this book provides a guide for assessing factors that contribute to abuse risk, as well as various clinical disorders resulting from experiences of child physical abuse. The development of a comprehensive treatment plan in accord with this model is nicely demonstrated.
This practice manual is a welcome addition to this expanding field, and will be a well-used and often-cited resource for beginning and experienced therapists.The University of Western Ontario
This book is the culmination of several rewarding years of professional training, clinical service, and applied research, but it would not have been possible without the influence and inspiration of many individuals. First, I am grateful to my wife, Judith, for her encouragement of my clinical research work with abuse victims and offenders. My parents, Dvorah and Myron, have been unwavering models of the supportive and constructive approaches to behavior change described in this book. For their support of my professional interests in this field, I wish to acknowledge the early and current mentoring of Alan Kazdin, PhD, and David Brent, MD, respectively. My colleagues Lucy Berliner, Mark Chaffin, Judith Cohen, Esther Deblinger, and Tony Mannarino have provided for more than a decade sound advice and exceptional professional examples in treating and evaluating child abuse victims and their families using cognitive-behavioral treatment procedures. In particular, David Wolfe's original work on the treatment of child physical abuse was both pioneering and insightful. Other colleagues—notably, Sharon Hicks, Diane Holder, and James Alexander—provided advice and assistance in developing or administering our family treatment procedures. I also am grateful to the former National Center on Child Abuse and Neglect for the funds that supported my initial outcome study with physically abused children and their offending caregivers (90-CA-1459) and a subsequent services research study (90-CA-1547), and to the Office of Children, Youth, and Families of Allegheny County [Page xii](Pittsburgh) for collaborating in these studies. This outcome study, subsequently referred to as Project IMPACT (Interventions to Maximize Parent-Child Togetherness), incorporated many of the techniques and materials described in this book. Finally, I wish to acknowledge the col-legiality and ongoing academic encouragement of my many friends and associates at the University of Pittsburgh and Children's Hospital of Pittsburgh.
I would like to thank a number of people who have offered either personal or professional support and guidance. Foremost, I would like to thank my husband, Marshall. His sacrifices and belief in me and my work made my part of this endeavor possible. Much love and appreciation go to Theresa, Kevin, and Ricky for constant strength, and to Sarah, Elizabeth, and Holly for teaching me what is important to children. I would also like to thank my grandmothers, Elsie and Aline, who are my heart; Paporan; and my parents—Bobbie Lewis Cupit, Joseph Cupit, Mary Margaret Marshall McClure and Ralph Swenson—for being a guiding force even at times when they did not realize it.
I thank my very wise mentors, Wally Kennedy and Scott Henggeler, for professional guidance and support of my ideas. To Cathy Joyner, for help in trying out the techniques and helping me stay on the path, and to Kevin Taylor for his help in demonstrating the breathing techniques. I would like to thank the Camp Stern group and Renae, Eve, Sonja, Julie, Elissa, Wahini, and Jay Basco for days, months, and years of love and support. Thanks to Art, Claudia, Elizabeth, Kelly, Mary, and Todd for teaching me to go the distance. To Toby, for being primarily responsible for keeping my sanity intact for the last year. Finally, I owe a great debt of gratitude for the support of my many friends and adopted family in Union Heights, especially Ida Taylor who daily helps me keep my understanding in the right place.
This book is dedicated to my wife, Judith, and my children, Rachel and Aaron, who bring love and fulfillment to my life. Their support and affection defy even the thought of mistreatment of any kind. (DJK)
This book is dedicated to Marshall, a truly great person with whom I have had the fortune of spending a large portion of my life.
This book is also dedicated to the memory of my children who gave me an understanding of the urgency with which we must cherish and protect all children for they are so precious and time is so short. (CCS)[Page xiv]
About the Authors[Page 345]
David J. Kolko, PhD, is Professor of Psychiatry, Psychology, and Pediatrics, at the University of Pittsburgh School of Medicine. At Western Psychiatric Institute and Clinic, he directs the Special Services Unit, a treatment research program for sexually offending youth referred by the Juvenile Court. Dr. Kolko is a consulting psychologist for the Pittsburgh Child Advocacy Center at Children's Hospital of Pittsburgh, a multidisciplinary child abuse program. He has just concluded a second term on the Board of Directors of the American Professional Society on the Abuse of Children (APSAC) and was chair of its research committee.
Dr. Kolko's federal and state grant funding has been directed towards the study and treatment of disruptive disorders, juvenile sexual offending, child physical abuse, and adolescent depression. Much of the work described in this book is based on a treatment outcome study with physically abused children and their parents or families (NCCAN 90-CA-1459) and was informed by other work directed towards understanding the service delivery system in child abuse (NCCAN 90-CA-1547). His other research has involved the development and evaluation of integrated mental health treatments and probationary services for juvenile sexual abusers (Pennsylvania Commission on Crime and Delinquency), the evaluation of a multimodal community-based treatment protocol for young children with disruptive, called REACH (Resources to Enhance the Adjustment of CHildren; NIMH [Page 346]Grant 57727), and behavioral health services for children with behavior problems in primary care, called SKiP (Services for Kids in Primary Care; NIMH Grant 63272).
Dr. Kolko received his BA in Psychology from the University of Cincinnati, his MA in general psychology from the New School for Social Research, and his PhD in clinical psychology, with a specialization in behavior therapy, from Georgia State University.
Cynthia Cupit Swenson, PhD, is Associate Professor of Psychiatry and Behavioral Sciences at the Medical University of South Carolina. Her work primarily consists of research on community-based treatment for youth violence, child physical abuse, family violence, and community violence. Currently, via a grant funded by the National Institute of Mental Health, she is involved in examining treatment for adolescents and their families when physical abuse occurs.
Dr. Swenson is a frequently invited speaker around the United States, and has written numerous publications in the field. At the national level, she is a member of the Board of Directors of the American Professional Society on the Abuse of Children (APSAC) where she serves on the Executive Council. Dr. Swenson also participates on a number of state boards related to child maltreatment and youth drug court. In addition, she is on the board of a youth West African dance and drumming company, as well as other community-based service and development organizations.
Dr. Swenson received her MS in psychology from Northeast Louisiana University and her PhD in clinical psychology from The Florida State University.