CHILD PARENT PSYCOTHERAPY FOR FAMILY VIOLENCE (CPP-FV)

OVERVIEW

The Child Parent Psychotherapy for Family Violence (CPP-FV) program is a clinic-based intervention for parents and their young children who belong to families with a history of maltreatment. The intervention focuses on improving parent-child relationships by making parents aware of how their own past maladaptive relationships influence their relationships with their children. Therapists work to help the parents interact positively with their children. In one evaluation of the program, 87 mother-child pairs belonging to families with a documented history of maltreatment were randomly assigned to one of the following three groups: 1) the Preschool Parent Psychotherapy (PPP) intervention, 2) the Psychoeducational Home Visitation (PHV) intervention, or 3) the community standard (CS) control group. Results indicated that children receiving the PPP intervention showed a greater decrease in negative self-views than children in the PHV or CS groups. In another evaluation, both CPP intervention mothers and children showed significantly improved behavior and traumatic stress symptoms.

DESCRIPTION OF PROGRAM

Target population: Parents and their children between the ages of 0 and 6 belonging to families with histories of child maltreatment.

The Child Parent Psychotherapy for Family Violence (CPP-FV) program is a clinic-based family-focused intervention that focuses on improving parent-child relationships. Parents and children attend weekly, 60-minute therapy sessions for one year. The therapists assess and provide information on how the parents' past experiences, specifically past dysfunctional relationships, are affecting their current relationships with their children. The therapists and parents work together to improve upon the dysfunctional aspects of the parent-child relationships. The ultimate goal of the program is to improve parental sensitivity, responsivity, and relationship harmony. In turn, children should develop more positive parent and family views.

EVALUATION(S) OF PROGRAM

Toth, S.L., Maughan, A., Manly, J.T., Spagnola, M., & Cicchetti, D. (2002). The relative efficacy of two interventions in altering maltreated preschool children's representational models: Implications for attachment theory. Development and Psychopathology, 14, 877-908.

Evaluated population: The sample for this evaluation was 87 mother-child pairs, belonging to families with a documented history of maltreatment, served as the sample for this evaluation. (Another sample of 35 mothers and their children, belonging to families without a history of maltreatment, served as a comparison group in the study, but were excluded from this evaluation summary.) Children were 4 years old, on average, at the time of recruitment.

Approach: Participants from the maltreated families were randomly assigned to one of three groups: 1) the Preschool Parent Psychotherapy (PPP) intervention, 2) the Psychoeducational Home Visitation (PHV) intervention, or 3) the community standard (CS) control group. Across all three groups the Department of Social Services (DSS) provided the standard services to all of the study participants.

Mothers and children receiving the PPP intervention met together with a clinical therapist for weekly, 60-minute sessions primarily at a center over the course of one year. During this time, therapists helped mothers to recognize how their past maladaptive relationships may be affecting their current parent-child relationships. The therapists and parents worked together to improve upon the dysfunctional aspects of the parent-child relationships.

Mothers in the PHV groups met with therapists in 60-minute sessions over a one-year period in a home-based setting. The therapists first worked with the mothers to assess various parent and family risk factors to which the children were exposed. During the therapy sessions, mothers were taught cognitive-behavioral techniques to reduce child risk. The therapists focused on altering mother-child interactional patterns and teaching more adaptive parenting skills. In addition to the parent services, the children in the PHV groups were enrolled in a 10-month, full day preschool program that provided school readiness and adaptive peer relationship skills.

All child participants, from both maltreatment and non-maltreatment families, were administered narrative story-stem assessments at baseline and during the post-intervention period. In these assessments, children were presented with incomplete stories depicting moral and emotionally charged events in the context of parent-child and family relationships. They then were asked to finish the stories in any way they would like. Story content was scored to assess child self- and maternal-views as well as mother-child relationship expectations. Mother's adaptive and maladaptive self-views, as well as their parent-child relationship expectations, were also assessed.

Results: Results indicated that children receiving the PPP intervention displayed a greater decrease in negative self-views than children in the PHV or CS groups.

Lieberman, A. F., Van Horn, P., & Ghosh Ippen, C. (2005). Toward evidence-based treatment: Child-parent psychotherapy with preschoolers exposed to marital violence. Journal of the American Academy of Child & Adolescent Psychiatry, 44(12), 1241-1248.

Lieberman, A. F., Ghosh Ippen, C., & Van Horn, P. (2006). Child-parent psychotherapy: 6-month follow-up of a randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 45(8), 913-918.

Evaluated population: 75 children (39 girls) age 3 to 5 that had witnessed or heard marital violence and their mothers participated in this evaluation. 39 percent of the children were of mixed ethnicity, 28 percent were Latino, 15 percent were African American, and 9 percent were white. In addition to marital violence, most mothers reported other traumatic stressors.

Approach: The mother-child dyads were randomly assigned to the CPP intervention or to a comparison group. Dyads received $30 upon intake and $40 after the outcome assessment.

Participants assigned to the CPP intervention received 50 weeks of 60-minute parent-child sessions with master's and Ph.D. level trained clinicians. The sessions involve child-parent interaction and child's free play with toys selected to elicit trauma and social interaction. The sessions target maladaptive behaviors, developmentally appropriate interactions, and work toward a joint narrative and resolution of the traumatic events.

The comparison group received monthly case management from a Ph.D. level clinician. They were free to call their clinician at any time and received at least a monthly phone call (lasting approximately 30 minutes) from the clinician. When indicated, face-to-face meetings could be scheduled. The clinicians also provided referrals to community services.

Children's behavior, traumatic stress levels, and exposure to violence were measured at baseline, six months, and at the conclusion of treatment. Mother's life stressors, psychiatric symptoms, and traumatic stress levels were assessed at the same points as their children.

Results: There was a significant reduction in traumatic stress disorder symptoms at post-test among children in the CPP group, while the comparison group showed no change. Again, only the CPP group children showed significant reductions in behavior problems at post-test. These impacts were significant at a six-month follow-up. Compared with the comparison group, at post-test, the CPP group had significantly less children meeting the requirement for traumatic stress disorder.

CPP group mothers showed significantly fewer posttraumatic stress disorder avoidance symptoms at post-test when compared with comparison group mothers. Both groups showed significantly fewer posttraumatic stress disorder symptoms and less psychiatric stress at post-test; however, CPP mothers had stronger impacts. At a six-month follow-up, CPP group mothers showed a significant difference on maternal functioning (as measured by the Global Severity Index) when compared with the comparison group.

SOURCES FOR MORE INFORMATION

Link to program manual: http://www.amazon.com/Dont-Hit-Mommy-Child-parent-Psychotherapy/dp/0943657849/

Information on implementing this program can be obtained from:

Patricia Van Horn, J.D., Ph.D.

Box 0852, SFGH CTRP

University of California, San Francisco

San Francisco, CA 94143-0852

E-mail: patricia.vanhorn@ucsf.edu

References:

Program categorized in this guide according to the following:

Evaluated participant ages: 4 to 5 years old

Evaluated participant grades: N/A

Program age ranges in the guide: Early Childhood, Middle Childhood

Program components: Counseling/Therapy, Clinic/Provider-Based, Home Visiting, Parent or Family Component

Measured outcomes: Social and Emotional

KEYWORDS: Early Childhood (0-5), Clinic-based, Children (3-11), Home Visitation, Case Management, Disruptive Behavior Disorders (Conduct Disorder, Oppositional Defiant Disorder, Attention-Deficit Hyperactivity Disorder), Violence, Post-Traumatic Stress Disorder, Family Conflict, Child Maltreatment, Parent-management Skills, Conflict Resolution Skills, White or Caucasian, Black or African American, Hispanic or Latino, Asian, parent-child relationship, co-ed, manual.

Program information last updated on 5/14/09.

		© Child Trends 2003