Child physical abuse (CPA) and violence within families is a highly prevalent public health problem. CPA has been associated with a wide range of debilitating psychosocial sequelae, such as post-traumatic stress disorder (PTSD), depression, behavioral problems, and violence towards others. The documented long-term effects of CPA, in conjunction with its widespread prevalence, support the urgent need to develop and refine evidence-based, culturally competent treatment strategies that target this population. The goal is to meet the needs of both the children and parents and to reduce the recurrence of CPA.
In 1990, while completing a Master of Science degree in clinical psychology at Eastern Kentucky University, I submitted paperwork to obtain a practicum at the University Counseling Center, where I would provide therapy to the worried-well, students with school performance anxiety, and a myriad of adjustment difficulties. Unfortunately, this coveted placement was assigned on a first-come, first-served basis and I was placed at the Methodist Home of Kentucky, which for all intents and purposes was a modern day orphanage. It was essentially a way-station for children who had suffered abuse, been removed from their families, and exhausted all other possible placements due to their significant emotional and behavioral difficulties. Being fortunate enough to grow up in a loving, two parent family, although in an economically-disadvantaged region of Eastern Kentucky in the heart of the Appalachia Mountains, I lived a sheltered life and was not exposed to the atrocities that children sometimes experience at the hands of family members.
While I now realize that child abuse is a significant issue for my community and other communities, it did not occur in my family, and in the community was hidden beneath the veil of secrecy that perpetuates abuse and violence within families in our society. During my training at the Methodist Home, I began to hear stories from children about abuse, including one from a child who had emotional and physical scars after being disciplined by having pieces of flesh removed from the bottoms of his feet with a construction tool. Some children were on 5 to 7 medications to control their behavioral disorders and the medication-induced physiological side effects. These obvious gaps in service delivery, the lack of family intervention and involvement, and the poor understanding of the needs of this group of traumatized children inspired me with a strong clinical and research interest, which I have been committed to for the past 17 years.
After completing my schooling and starting a child abuse specialty treatment clinic in South Florida, I realized that it was not sufficient to provide services to underserved populations. It was also important to conduct outcome research to determine the effectiveness of those services for the families being served. In 1999, I accepted a faculty position at the UMDNJ-School of Osteopathic Medicine’s CARES Institute, where I have had the opportunity to collaborate with and be mentored by Esther Deblinger, PhD, a nationally known researcher in the area of child sexual abuse and be supported in developing a federally-funded research program.
|The CARES Institute Physical Abuse Research Team (from left to right): Donyale Baker, MSW, therapist; Beth Cooper, MS, research coordinator; Melissa K. Runyon, PhD, principal investigator; Alissa Glickman, PhD, therapist; Eloise J. Berry, PhD, former CARES therapist; Esther Deblinger, PhD, co-investigator; and Leah Behl, PhD, therapist.|
In a society where standard community treatment for child physical abuse generally consists of parenting classes offered to large groups, I am proud to say that my colleagues and I have conducted research to develop an evidence-based model, Combined Parent-Child Cognitive Behavioral Treatment (CPC-CBT) for children and families at risk for child physical abuse. The comprehensive CBT model provided at the Institute consists of 16 sessions. These sessions encourage the involvement of the parent who is engaging in abusive behavior, the non-offending parent, and the children. The program helps children and parents to strengthen their relationships, improves their ability to communicate with one another, and empowers them to develop healthy outlooks and peaceful home environments.
Not only are our therapists helping children heal from the abuse they have experienced, they are also working with parents to manage their emotions and to learn to parent their children in a non-violent, non-coercive manner. Their relationships heal as they communicate openly about the abusive experiences, and parents dispel any thoughts of self blame or guilt that children experience.
To examine families’ responsiveness to the treatment, a small pilot study was conducted that examined pre- to post-treatment changes on standardized measures for 9 families with 16 children, ages 4 to 14. After their participation in the 16-week group program, both parents and children reported significant reductions in the use of corporal punishment. Parents also reported significant improvements in parental anger and children’s internalizing and externalizing behavior problems, while children reported improvements in their post traumatic stress and depressive symptoms after their participation.
In 2003, I was awarded funding from the National Institute of Mental Health to compare two cognitive-behavioral treatments: (1) group Combined Parent-Child Cognitive Behavioral Therapy, addressing the needs of the child and the offending parent in families in which physical abuse occurs, and (2) group CBT for the offending parent only. This is the first study of its kind to examine the direct benefit of including the child in the abusive parents’ treatment. Seventy-five children, ages 7 to 13, and their parents who were either substantiated for or at-risk for CPA were recruited and randomly assigned to one of the two treatment types. While this study has just been completed, preliminary findings suggest that group Combined Parent-Child CBT is a promising approach for helping children and families. This study replicated findings from our pilot study described above.
I continue to be impressed by these parents’ commitment to participate in treatment. I believe this is not only a testament to our treatment team’s ability to build therapeutic relationships with the families and engage them in the treatment process, but also to the parents’ commitment to their children and strengthening their relationships. Our team at the CARES Institute has given many families a powerful gift by strengthening their relationships and assisting parents in finding joy in parenting their children. These findings suggest that CPC-CBT may be an important tool in helping to heal children and families and stop the cycle of violence.
Melissa K. Runyon, PhD, a licensed clinical psychologist, is Treatment Services Director and associate professor of psychiatry at the Child Abuse Research Education and Service (CARES) Institute at UMDNJ-School of Osteopathic Medicine. CARES is a nationally recognized program that is a center of the National Child Traumatic Stress Network (NCTSN). The NCTSN has identified Combined Parent-Child Cognitive Behavioral Therapy as a promising practice.