46. Becker, J. V., Alpert, J. L., Subia-BigFoot, D., Bonner, B. L., Geddie, L. F., Henggeler, S. W., Kaufman, K. L., & Walker, C. E. (1995). Empirical research on child abuse treatment: Report by the Child Abuse and Neglect Treatment Working Group, American Psychological Association. Journal of Clinical Child Psychology, 24 (Suppl.), 23-46.
74. Swenson, C.C., & Hanson, R.F. (1998). Sexual abuse of children: Assessment, research, and treatment. In J.R. Lutzker (Ed.), Handbook on Research and Treatment in Child Abuse and Neglect (475-499), New York: Plenum.
75. Lipovsky, J.A., Swenson, C.C., Ralston, M.E., & Saunders, B.E. (1998). The abuse clarification process in the treatment of intra familial child abuse. Child abuse and neglect, 22(7), 729-741.
76. Saylor, C.F., Swenson, C.C., Reynolds, S.S., Taylor, M. (1999). The pediatric emotional distress scale: A brief screening measure for young children exposed to traumatic events. Journal of Clinical Child Psychology, 28, 70-81.
77. Swenson, C.C., & Kolko, D.J. (2000). Long-term management of the developmental consequences of child physical abuse. In R. Reese (Ed.), The treatment of child abuse, 135-154.
78. Lutzker, J.R., Bigelow, K.M., Swenson, C.C., Doctor, R.M., & Kessler, M.L. (1999). Problems related to child abuse and neglect. In S. Netherton, D. Holmes, & C.E. Walker (Eds.), Comprehensive Textbook of Child and Adolescent Disorders: A Guide to DSM-IV. (pp. 52-548). Oxford: Oxford University Press.
79. Swenson, C.C., & Spratt, E.G. (1999). Identification and treatment of child physical abuse through medical and mental health collaborations. Children's Health Care, 28(2), 123-139.
80. Swenson, C.C., & Brown, E.J. (2002). Cognitive-behavioral group treatment for physically-abused children: A case study. Cognitive and Behavioral Practice.
81. Ezzell, C. E., Swenson, C.C., & Faldowski, R. (1999). Child, family, and case characteristics: Links with service utilization in physically abused children. Journal of Child and Family Studies, 8, 271-284.
82. Swenson, C.C., & Ezzell, C. E. (2000). Child Abuse. In G. Fink (Ed.), Encyclopedia of Stress, 1, 438-442.
103. Brunk, M., Henggeler, S. W., & Whelan, J. P. (1987). A comparison of multisystemic therapy and parent training in the brief treatment of child abuse and neglect. Journal of Consulting and Clinical Psychology, 55, 311-318.
201. Ezzel, C. E., Swenson, C.C.,Brondino, M.J. (2000). The relationship of social support to physically abused children's adjustment. Child Abuse & Neglect, 24(5), 641-651.
204. Swenson, C.C., Randall, J.,Henggeler, S.W., Ward, D. (2000). The outcomes and costs of an interagency partnership to serve maltreated children in state custody. Children's Services: Social Policy, Research, and Practice, 3(4), 191-209.
220. Kolko, D. J., Swenson, C.C. (2002). Assessing and treating physically abused children and their families. Thousand Oaks, CA: Sage. (Book)
234. Swenson, C.C., Brown, E.J., Sheidow, A.J. (2003). Medical, legal, and mental health service utilization by physically abused children and their caregivers. Child Maltreatment Journal of the American Professional Society on the Abuse of Children, 8(2), 138-144.
289. Swenson, C.C., Chaffin, M. (2006). Beyond psychotherapy: Treating abused children by changing their social ecology. Aggression and Violent Behavior, 11, 120-137.
296. Swenson, C.C., Saldana, L., Joyner, C.D., & Henggeler, S.W. (2006). Ecological treatment for parent to child violence. Lieberman, A.F., & DeMartino, R. (Eds.), Interventions for children exposed to violence (pp. 155-185). New Brunswick, New Jersey: Johnson & Johnson Pediatric Institute.
306. Swenson, C.C., Brown, E.J., Lutzker, J.R. (2007). Issues of maltreatment and abuse. Freeman, A., Reinecke, M.A.(Eds.). Personality Disorders in Childhood and Adolescence. John Wiley & Sons, Inc.
338. Swenson, C.C., Schaeffer, C.M., Tuerk, E.H., Henggeler, S.W., Tuten, M., Panzarella, P., Lau, C., Remmele, L., Foley, T., Cannata, E., & Guillorn, A. (2009). Adapting multisystemic therapy for co-occurring child maltreatment and parental substance abuse: The building stronger families project. Emotional & Behavioral Disorders in Youth, 3–8.
382. Swenson, C. C., Schaeffer, C. M., Henggeler, S. W., Faldowski, R., Mayhew, A.M. (2010). Multisystemic therapy for child abuse and neglect: A randomized effectiveness trial. Journal of Family Psychology, 24(4), 497-507.
414. Swenson, C.C., & Schaeffer, C.M. (2012). Multisystemic Therapy for child abuse and neglect. In A. Rubin (Ed.), Clinician's guide to evidence-based practice: Programs and interventions for maltreated children and families at risk (pp. 31-41). Hoboken, New Jersey: John Wiley & Sons, Inc.
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46. Empirical research on child abuse treatment
Reviewed empirical research on the short-and long-term effects of four major types of child maltreatment (physical abuse, sexual abuse, psychological abuse, and neglect). Outcome research for a variety of treatments for child victims of abuse and for adults abused as children suggests that treatment is effective; however, comprehensive and carefully designed studies have not been done. Likewise, outcome research for treatment efforts with parents and caregivers who engage in child maltreatment is limited, but evidence supports treatment efficacy. Thirteen recommendations are offered pertaining to improvement of conceptualization, treatment, and research in the area of child maltreatment.
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74. Sexual abuse of children: Assessment, research and treatment
Child sexual abuse (CSA) had been the focus of considerable attention among researchers, clinicians, the courts, and recently, the news media. In many cases assessment and treatment techniques have been under close scrutiny and professionals have been challenged to demonstrate the effectiveness of their work. More than ever, research-based methods are needed. This chapter presents research on assessment and treatment of sexually abused children. First, the prevalence of child sexual abuse is discussed. Second, mental health consequences related to CSA are summarized. Third, clinical assessment of sexually abused children and their families is reviewed. Finally, treatment of sexually abused children and their families is examined.
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75. The abuse clarification process in the treatment of intrafamilial child abuse
Objective: One aspect of treatment for child abuse and neglect addresses the attributions that the child victim offender, nonoffending parents, and other family members have about the occurrence of the maltreatment. This paper describes a formal approach for abuse clarification to be used with families in which maltreatment has occurred. The four primary components of the abuse clarification process are: (a) clarification of the abusive behaviors; (b) offender assumption of responsibility for the abuse; (c) offender expression of awareness of the impact of the abuse on the child victim and family; and (d) initiation of a plan to ensure future safety. The process of abuse clarification is described and suggestions made for appropriate use of the procedure.
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76. The pediatric emotional distress scale: A brief screening measure for young children exposed to traumatic events
Introduced the Pediatric Emotional Distress Scale (PEDS), which was developed to quickly assess behaviors identified in empirical and theoretical literature as significantly elevated in children after experiencing traumatic events. The 21-item parent-report rating scale includes 17 general behavior items and 4 trauma-specific items. Factor analyses on the 17 items, with 475 two- to ten-year-olds (Traumatic event exposure and nontraumatic event exposure), yielded 3 reliable factors labeled Anxious/Withdrawn, Fearful, and Acting Out. Factor and total scores were shown to have good internal consistency, and both test-retest and interrater reliability were at acceptable levels. Discriminant analyses demonstrated the PEDS could distinguish traumatic event exposure and nonexposure groups, although maternal education
should be a significant consideration in interpretation. Future research with diverse populations who have documented trauma is needed to enhance the utility of the full PEDS scale.
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77. Long-term management of the developmental consequences of child physical abuse
Physically abused children appear to experience multiple behavioral, emotional, and cognitive impairments as a result of abuse. Long-term mental health management of the child and family is necessary. Unfortunately, we have little definitive data including which approaches work best, and management techniques must be determined on the basis of individual child and family needs. Because of the multiple causes of physical abuse, assessment and treatment should be comprehensive and
should incorporate a variety of different methods. Cognitive behavioral therapy, effective with other populations, may play an important role. Long-term management must include work with the child, the parents, and the family, as well as coordination with other systems such as child should protective services, law enforcement, and the schools. Work with the child should address trauma-related emotional symptoms, anger management, and social competence, and family sessions need to deal with attributions and clarification of the abuse.
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78. Problems related to child abuse and neglect
(from the chapter) Notes that there are 2 elements in the treatment and prevention of child abuse and neglect (CAN): teaching new skills to parents and typing to alter their social ecologies to help alleviate the apparent stressors that contribute to CAN and providing ameliorative treatment to the victims of CAN. This chapter focuses on what empirical work exists in both of these areas.
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79. Identification and treatment of child physical abuse through medical and mental health collaborations
Physically abused children often require medical and mental health services. Professionals from both disciplines should be aware of critical issues related to child physical abuse (CPA) and ways in which they may work collaboratively to identify and treat abuse. In this article we present an overview of prevalence, etiology, identification, and common sequalae associated with CPA. Current psychosocial treatment models are reviewed and challenges and future directions regarding identification and treatment of physical abuse are discussed. The need for collaborative efforts between medical and mental health professionals is emphasized.
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80. Cognitive behavioral group treatment for physically-abused children: A case study
The purpose of this case study was two-fold: (1) to assess the feasibility of implementing a multiple-module, 16-week cognitive-behavioral group treatment program for physically-abused children; and (2) to evaluate preliminary data from this group treatment program designed to address the multiple sequelae common to school-aged physically abused children (i.e., aggression and other behavioral problems, social skills deficits, and trauma-related symptoms). Results indicate that the multiple components of this group treatment were implemented successfully and allowed for flexibility across children, even within a group format. Preliminary pre-post data show decreases on self report measures of trauma-related emotional symptoms targeted by the group treatment. Increases were evident in parent ratings of children’s internalizing and externalizing behaviors. Interpretations of these findings and future research recommendations are discussed.
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81. Child, family and case characteristics: Links with service utilization in physically abused children
We investigated the relationships between child, familial, and case characteristics and mental health and medical health care service utilization by physically abused children. Participants included 26 parents or caregivers of 37 Medicaid-eligible children who had substantiated cases of physical abuse. Children whose female caregivers reported a greater number of stressors were more likely to receive mental health care. Furthermore, children not living with the maltreating caregiver were more likely to receive medical health care services. Results are discussed in terms of factors that may account for these links, and the similarities of these findings with those of service utilization in general and clinical child samples.
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103. A comparison of multisystemic therapy and parent training in the brief treatment of child abuse and neglect
This study evaluated the relative efficacy of two promising treatments of child abuse and child neglect: parent training and multisystemic therapy. Subjects included 18 abusive families and 15 neglectful families who were randomly assigned to the treatment conditions. Self-report and observational measures were used to evaluate the effects of treatment at three levels that have been associated with child maltreatment: individual functioning, family relations, and stress/social support. Statistical analyses revealed that families who received either treatment showed decreased parental psychiatric symptomology, reduced overall stress, and a reduction in the severity of identified problems. Analyses of sequential observational measures revealed that multisystemic therapy was more effective than parent training at restructuring parent-child relations. Parent training was more effective than multisystemic therapy at reducing identified social problems. The differential influences of the two treatments were probably associated with differences in their respective treatment contexts and epistemologies.
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201. The relationship of social support to physically abused children’s adjustment
Objective: This study had three main objectives: First, to assess physically abused children’s perception of teacher, peer, and family support; second, to determine whether the levels of perceived support differ according to the person’s social role; and third to assess which sources of social support show stronger associations with adjustment in a physically abused sample. Method: Perceived social support from teachers, families, and peers assessed in a sample of 37 physically abused children using a shortened version of the Survey of Children’s Social Support (Dubow & Ullman, 1989). Child adjustment was indexed by child and parent reports of child depression, anxiety, and anger. Results: Analyses indicated that the children rated their families, peers, and teachers highly sources of social support, with families being rated as the most important source. Hierarchical multiple regression analyses indicated that perceived peer support was significantly negatively associated with child reported depression, No significant relationships were found between perceived teacher support and symptomatology. Conclusions: Overall, the results suggest that peer and family support are particularly important for particularly important for physically abused children’s psychological functioning, particularly for internalizing problems.
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204. The outcomes and costs of an interagency partnership to serve maltreated children in state custody
The primary objective of the Charleston Collaborative Project (CCP) was to develop and implement a clinical and cost-effective interagency collaboration that provided a single point of entry and a seamless system for providing services. The CCP successfully developed such a system with collaboration among 1 private and 3 state agencies that serve maltreated children taken into custody. Although implementation of the collaborative was not optimal, the available evidence does not support the view that the CCP was more effective than Current Services at improving child and caregiver functioning, increasing family reunification, or decreasing use of out-of-home care. When a comprehensive range of costs is considered, evidence suggests that the CCP produced modest cost savings. The lack of favorable clinical findings is consistent with treatment effectiveness literature pertaining to community-based mental services. Policy implications are outlined.
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220. Assessing and treating physically abused children and their families
Written for those already in the field as well as practitioners-in-training, this volume is the first attempt to provide a comprehensive, practical approach to the assessment and treatment of physically abused children and their families. The presentation includes an overview of child physical abuse (including statistics and consequences), outcome studies and treatment implications, and assessment and treatment techniques. These empirically validated techniques will help practitioners:
1.Understand abuse experiences and exposures to violence; expose thinking errors or negative attributions; help abused children manage anxiety and anger; and develop social skills and safety plans,
2.Assist parents with child management and development, expectations and cognitive distortions, behavior management, and discipline,
3.Facilitate family communication and problem solving,
4.Assess factors that contribute to abuse risk, as well as various clinical disorders resulting from experiences of child physical abuse.
Containing practical features such as case studies, hand-outs, and worksheets, Assessing and Treating the Physically Abused and Their Families: A Cognitive-Behavioral Approach will serve as a valuable tool for practitioners and students in the areas of interpersonal violence, child abuse, counseling, and social work.
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289. Beyond psychotherapy: Treating abused children by changing their social ecology
Historically, the child abuse field has approached intervention through individually focused child or adult psychotherapy. A more comprehensive understanding of current research indicates that the field is moving beyond individually focused models. Existing research on child sexual abuse, physical abuse, and neglect suggests that multiple factors within the child’s social ecology relate to the occurrence of abuse and to its mental health impact. This article reviews the literature on child sexual abuse, physical abuse and neglect with an emphasis on social ecological factors related to abuse, recovery, and interventions. An approach to intervention is suggested that emphasizes potential target areas and interventions from across multiple systems (e.g., individual, family, school, child protection system).
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296. Ecological treatment for parent to child violence
Parental violence towards a child increases the child's risk of developing serious mental health problems and, in the long run, engaging in violent crime and other antisocial behaviors. Maltreated children who experience severe emotional problems often require costly therapy and services, such as residential care and/or hospitalization, and eventually exact a heavy toll on themselves, their families and society, in general. Despite the multiple and often grave consequences that result from violence, reducing its mental health impact and improving the functioning of abusive and/or at-risk families. To design effective interventions, clinicians should use as their guide existing child development literature and emerging findings on the links between children's physical factors and the multiple factors within the different systems with which the child interacts- parents, the family and the child's and family's social networks.
In this chapter, we outline an ecological conceptualization of and a treatment for parent-to-child violence. First, we present an empirical background of the mental health correlates of parent-to-child violence. Then we review the risk factors for child physical abuse in order to illustrate the need for an ecological treatment model. We describe recent work on applying an ecological treatment model and Multisystemic Therapy (MST) to parent-to-child violence.
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306. Issues of maltreatment and abuse
Child abuse and neglect is a major public health problem that impacts millions of children and families annually. The impact may come in many forms. Of particular concern and pertinent to this chapter are the potential health and mental health outcomes. Some children will not experience mental health difficulties from being the victims of child maltreatment. For others, mental health sympomatology will be short term and may dissipate without formal intervention. Most disconcerting are those children for whom abuse and neglect experiences in childhood set patterns of behavior and coping that, though initially adaptive, become disruptive to the management of behavior, emotions, and relationships and can persist throughout the life course. For these youth, formal intervention may be helpful or even required. Witht regard to health, the stress and potential trauma from child maltreatment can impact biological systems and set a trajectory for poor health. The interaction of mental health and physical health problems related to abuse and neglect can impact individuals in such a way that lives are shortened and abusive and neglectful behavior is carried on through future generations.
In this chapter, we examine the role of abuse and neglect in negative life outcomes. First, we consider the short- and long-term effects of maltreatment. We then examine the scope of the problem of abuse and neglect. Last, we discuss clinical and treatment issues, including a review of the treatment research and indications for intensive or restrictive treatments.
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338. Adapting multisystemic therapy for co-occurring child maltreatment and parental substance abuse: The building stronger families project
Child maltreatment is a significant public health concern (U.S. Department of Health and Human Services [USDHHS],2008) and a major risk factor for a range of child mental health problems such as difficulties with emotion regulation, aggressive behavior, depression, anxiety, and suicidal ideation (Wekerlet et al.,2006). Unfortunately, the more than half a million youth removed from their homes annually due to child maltreatment face additional challenges (e.g., unstable placements, attachment difficulties, school disruptions) that exacerbate the risks associated with maltreatment alone (Bass et al., 2004).
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