This document was printed from the website of the California Evidence-Based Clearinghouse for Child Welfare (CEBC), which you can access at http://www.cachildwelfareclearinghouse.org/
This document was printed from the website of the California Evidence-Based Clearinghouse for Child Welfare (CEBC), which you can access at http://www.cachildwelfareclearinghouse.org/
Child Welfare Outcomes: Safety and child/family well-being.
Type of Maltreatment: Exposure to domestic violence, Physical abuse, and Physical neglect
Target Population: The program serves children under the age of seven, who have experienced a traumatic event and their caregivers.
Brief Description:
Child Parent Psychotherapy for Family Violence (CPP-FV) has been rated by the CEBC in the areas of Domestic/Intimate Partner Violence: Services for Women Victims and their Children and Trauma Treatment for Children. CCP-FV is a psychotherapy model that integrates psychodynamic, attachment, trauma, cognitive-behavioral, and social-learning theories into a dyadic treatment approach designed to restore the child-parent relationship and the child's mental health and developmental progression that have been damaged by the experience of domestic violence. Child-parent interactions are the focus of six intervention modalities aimed at restoring a sense of mastery, security, and growth and promoting congruence between bodily sensations, feelings, and thinking on the part of both child and parent and in their relationship with one another. (Description taken from the National Child Traumatic Stress Network website www.nctsn.org, 2006).
Provisional feedback form not available in printout. Please access the website to use the form.
Child Parent Psychotherapy for Family Violence (CPP-FV) was not designed to be conducted in a group.
Child Parent Psychotherapy for Family Violence (CPP-FV) has not been tested for use in a group setting.
Recommended intensity: One time per week.
Recommended duration: Each session should be 1 to 1.5 hours long and the sessions should occur over a period of 50 weeks
Child Parent Psychotherapy for Family Violence (CPP-FV) does not include a homework component.
Child Parent Psychotherapy for Family Violence (CPP-FV) is typically conducted in a(n): Adoptive Home, Birth Family Home, Foster Home, and Outpatient Clinic.
Child Parent Psychotherapy for Family Violence (CPP-FV) was designed with a Parent Component.
Child Parent Psychotherapy for Family Violence (CPP-FV) addresses the following presenting problems and symptoms: Encouraging the parent's support for the child's reactive experience to violence within the family.
Child Parent Psychotherapy for Family Violence (CPP-FV) was designed with a Child Component.
Child Parent Psychotherapy for Family Violence (CPP-FV) addresses the following presenting problems and symptoms: Exposure to trauma, internalizing and externalizing symptoms, and/or symptoms of posttraumatic stress disorder (PTSD).
Age range(s): 0-6
Child Parent Psychotherapy for Family Violence (CPP-FV) was not developed for children with developmental delays.
Child Parent Psychotherapy for Family Violence (CPP-FV) has not been tested for children with developmental delays.
Child Parent Psychotherapy for Family Violence (CPP-FV) was designed for specific racial/ethnic/cultural groups.
Child Parent Psychotherapy for Family Violence (CPP-FV) was tested in specific racial/ethnic/cultural groups.
Specific Groups: It was specifically developed with a group that was approximately 40% Latino, and it was developed with the needs of that group in mind.
Relevant research studies:
Cicchetti, D., Toth, S.L., & Rogosch, F.A. (1999). The efficacy of toddler-parent psychotherapy to increase attachment security in offspring of depressed mothers. Attachment and Human Development, 1, 34-66.
Examined the efficacy of the intervention, which they called Toddler-Parent Psychotherapy (TPP) when conducted with toddlers of depressed mothers. Toddlers and their mothers were randomly assigned to either TPP or to a non-intervention group; both were compared to a control group where the mother had no current or past mental disorder. At intake, children in all three groups showed no differences in scores on the Bayles Mental Development Index. However, at posttest, TPP children showed significantly higher cognitive abilities, compared to the children of depressed mothers who did not receive the intervention. TPP children did not differ from children in the control group (mother had no history of mental disorders).
Lieberman, A.F, Waston, D.R., and Jeree H, Pawl (1991). Preventive Intervention and Outcome with Anxiously Attached Dyads. Child Development, 62, 199-209.
Anxiously attached 12-month-olds and their mothers were randomly assigned to either and infant-parent psychotherapy intervention or a control group; securely attached dyads comprised a second control group. Intervention lasted one year and ended when the child was 24 months. ANOVAs (Analyses of Variance) were used to compare the research groups at outcome. Intervention group toddlers were significantly lower than anxious controls in avoidance, resistance, and anger. They were significantly higher than anxious controls in partnership with the mother. Intervention mothers had higher scores than anxious controls in empathy and interactivity with their children. There were no differences on the outcome measures between the intervention and the secure control groups. The groups did not differ in maternal child-rearing attitudes. Within the intervention group, level of therapeutic process was positively correlated with adaptive scores in child and mother outcome measures.
Lieberman, A.F., Van Horn, P.J., & Ghosh Ippen, C. (2005). Toward evidence-based treatment: Child-parent psychotherapy with preschoolers exposed to marital violence. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 1241-1248.
Conducted a randomized trial of CPP-FV with children aged 3-6 who had been exposed to domestic violence. Children were randomly assigned to either CPP-FV or to services in the community plus monthly case management. At post treatment, CPP-FV children showed significantly greater reductions in total behavior problems and traumatic stress symptoms. CPP-FV mothers showed significantly greater reductions in avoidant symptomatology.
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, 777-808.
Investigated the efficacy of CPP-FV in a sample of maltreated families. Maltreated preschoolers were randomly assigned to CPP-FV, psychoeducation home visitation, or to usual care. A comparison group of non-maltreating families was used. Measures included a set of narrative story-stems and an abbreviated version of the Wechsler Preschool and Primary Scales of Intelligence-Revised (WPPSI-R). At post test, CPP-FV children showed a greater decrease in negative self-representations than all three groups. They also showed significantly greater improvements in mother-child relationship expectations when compared to non-maltreating families and to families who received psychoeducational home visitation.
There is a manual that describes how to implement this program.
There is training available for Child Parent Psychotherapy for Family Violence (CPP-FV).
Training contact: Contact either Alicia F. Lieberman, Ph.D., 415-206-5377, alicia.lieberman@ucsf.edu or Patricia Van Horn, Ph.D., 415-206-5323, patricia.vanhorn@ucsf.edu
Number of days/hours: Typically training consists of an initial 3-day intensive training followed by bi-weekly case-specific telephone consultation. The trainer meets with individuals receiving training for an 8-hour "booster" session every three months for the year following the initial training.
Training is obtained: Training has been provided at UC-San Francisco and onsite at community agencies. It will also be provided regionally in a breakthrough series learning collaborative sponsored by the National Child Traumatic Stress Network.
There currently are additional qualified resources for training.
List of additional qualified resources: Betsy McAlister Groves, LCSW, at the Child Witness to Violence Project at Boston Medical Center;
Julie Larrieu, Ph.D., at the Orleans Parish Infant Team at Tulane University;
Joy Osofsky, Ph.D. at the Violence Intervention Program at the Louisiana State University Health Sciences Center
The typical resources for implementing Child Parent Psychotherapy for Family Violence (CPP-FV) are: Playroom with toys for young children and the capacity to videotape sessions.
Practitioners: Master's level training
Supervisors: Master's degree plus minimum of 1 year training in this intervention.
Child Parent Psychotherapy (CPP) is rated a "2 - Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one rigorous randomized controlled trial with a sustained effect of at least 6 months. For more information on the rating of a "2 - Supported by Research Evidence," please see the Scientific Rating Scale.
Lieberman, A.F., Ippen, C.G., & Van Horn, P. (2006). Child-Parent Psychotherapy: 6-month follow-up of a randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 45(8), 913-918.
Type of Study: Randomized controlled trial
Number of participants: 59 mother-child pairs
Population:
Location/Institution: California
Summary: (To include comparison groups, outcomes, measures, notable limitations) Note: This study uses the same sample as Lieberman, et al. (2005). Participants were randomly assigned to either the Child Parent Psychotherapy (CPP) treatment group or to a comparison group receiving case management and referral to individual treatment in the community for mother and child. Children's functioning was assessed using the Child Behavior Checklist (CBCL) and maternal symptoms of emotional distress were assessed using the Global Severity Index (GSI). In a comparison of baseline and 6-month follow-up scores, the CPP treatment children showed significant reductions in problems behaviors while the control group did not. Similarly, only the CPP group mothers showed a significant improvement in distress levels at 6 months. Limitations include small sample size and reliance on maternal report.
Length of post-intervention follow-up: 6 months
Lieberman, A.F., Van Horn, P., Ippen, C.G. (2005). Toward evidence-based treatment: Child-Parent Psychotherapy with preschoolers exposed to marital violence. Journal of the American Academy of Child and Adolescent Psychiatry, 44(12), 1241-1448
Type of Study: Randomized controlled trial
Number of participants: 75 mother child pairs
Population:
Location/Institution: California
Summary: (To include comparison groups, outcomes, measures, notable limitations) Participants were randomly assigned to either the Child Parent Psychotherapy (CPP) treatment group or to a comparison group receiving case management and referral to individual treatment in the community for mother and child. For the children the Child's Exposure to Community Violence: Parent Report Version, the Child Behavior Checklist (CBCL) were completed by parents. Clinicians also interviewed parents using the Semistructured Interview for Diagnostic Classification DC: 0-3 for Clinicians, which assesses traumatic stress disorder (TSD). Mothers completed the Life Stressor Checklist, the Clinician Administered PTSD Scale, and the Symptoms Checklist-90, which is a measure of psychiatric symptoms. Treatment was conducted over 50 weeks. CPP group children showed a significant decline in TSD symptoms and behavior problems at the conclusion of the study, while comparison group children did not. Mothers in the CPP group showed significant reductions in avoidant symptoms and there was a moderate effect on general distress and PTSD symptoms. Limitations include a small sample and reliance on maternal report.
Length of post-intervention follow-up: None
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.
Type of Study: Randomized controlled trial
Number of participants: 122 mothers and their preschool children
Population:
Location/Institution: Unknown
Summary: (To include comparison groups, outcomes, measures, notable limitations) Mothers of families with history of maltreatment and their children were randomly assigned the Parent Preschooler Psychotherapy (PPP), psychoeducational home visitation (PHV), or community standard (CS) groups. A comparison group of low-income mothers and children with no history of maltreatment was also included. At baseline and follow-up children were administered narrative story-stems to complete, which measured perceptions of parent-child relationships, parenting behavior, socio-emotional development, and behavioral adaptation. Intelligence was also assessed, using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-R). Results showed that the PPP children showed reductions in problematic maternal representations compared to PHV group children and greater reductions in negative self-representations compared to all other groups. Mother child-relationship expectations also became more positive than for non-maltreatment control and PHV groups.
Length of post-intervention follow-up: None
Cicchetti, D., Toth, S.L., & Rogosch, F.A. (1999). The efficacy of toddler-parent psychotherapy to increase attachment security in off-spring of depressed mothers. Attachment & Human Development, 1(1), 34-66.
Type of Study: Randomized controlled trial
Number of participants: 63 depressed mothers and 45 non-depressed control mothers
Population:
Location/Institution: Unknown
Summary: (To include comparison groups, outcomes, measures, notable limitations) Depressed mothers of young children were randomly assigned to receive the intervention or to a no-intervention control group. There was also a second control group of mothers from the same community who did not have any prior diagnosis of a mental disorder. At baseline the Diagnostic Interview Schedule (DIS-III-R) and the Beck Depression Inventory (BDI) were administered. Mothers were also asked to observe their child for two weeks and then complete the Attachment Q-set (AQS), which was used to assess the child's attachment behavior. At the end of the intervention, when the children were at 36 months, attachment was assessed again. Both the intervention and depressed control groups had had a higher proportion of insecurely attached children than the non-depressed control at baseline. At follow-up, the intervention group's proportion of insecurely attached children had decreased to the point that it was no longer significantly different from that of the non-depressed group, while the depressed control group experienced and increase in insecure attachment. This study is somewhat limited by the decision to omit mothers from low socioeconomic groups and the use of a more subjective method of classifying children's attachment.
Length of post-intervention follow-up: None
Lieberman, A.F., Weston, D.R., & Pawl, J.H. (1991). Preventive interaction and outcome with anxiously attached dyads. Child Development, 62, 199-209.
Type of Study: Randomized controlled trial
Number of participants: Intervention: 34; Anxious control: 25; Secure control: 34
Population:
Location/Institution: California
Summary: (To include comparison groups, outcomes, measures, notable limitations) After initial assessment using the Strange Situation, the Maternal Attitude Scale and the Life Event Inventory, which measures levels of potentially stressful events. Mother-infant pairs who were anxiously attached were assigned to an intervention group and a non-intervention control group. A second control group was also formed, consisting of pairs who were found at baseline to be securely attached. At 24 months, the measures used at baseline were re-administered. The observational measure at this phase was a longer version of the Strange Situation. Intervention group pairs had higher scores in empathic responsiveness and goal-corrected partnership and lower scores on angry behavior by the child than anxious control pairs. However, the intervention group did not differ from the anxious group on attachment security, although intervention children were less likely to show proximity avoidance and contact resistance. Both groups improved in maternal child-rearing attitudes over time. Although the secure control group still had higher secure attachment scores at the follow-up, the intervention and secure control groups did not differ significantly on other outcomes at 24 months.
Length of post-intervention follow-up: None
Lieberman, A.F., & Van Horn, P. (2004). Don't hit my mommy: A manual for child parent psychotherapy with young witnesses of family violence. Zero to Three Press: Washington, D.C.
Contact name: Patricia Van Horn, J.D., PhD.
Affiliation/Agency: UC-San Francisco
Email: patricia.vanhorn@ucsf.edu
Phone: 415-206-5323
Fax: 415-206-5328