Program

May 14, 2009

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:

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.

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.

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.