Elsevier

Child Abuse & Neglect

Volume 20, Issue 1, January 1996, Pages 23-43
Child Abuse & Neglect

Clinical monitoring of treatment course in child physical abuse: Psychometric characteristics and treatment comparisons,☆☆

https://doi.org/10.1016/0145-2134(95)00113-1Get rights and content

Abstract

Weekly reports of high-risk indicators designed to monitor the course of treatment were obtained from physically abused, school-aged children and their parents/guardians who were randomly assigned to Individual Child and Parent Cognitive-Behavioral Treatment (CBT) or Family Therapy (FT). Measures of parental anger and physical discipline/force, and family problems were obtained each session. The measures showed moderate stability and parent-child correspondence. Between 20% and 23% of the two informant's reports acknowledged high levels of physical discipline/force during the early and late phases of treatment, respectively, and an even higher percentage of cases reported heightened parental anger and family problems. Early treatment reports from both informants predicted late period reports, but only parent reports were related to validity measures. The overall levels of parental anger and physical discipline/force were lower in CBT than FT families, though each group showed a reduction on these items from the early to late treatment sessions. The importance of routine monitoring of clinical course during intervention, especially in the identification of cases at-risk of reabuse, is discussed.

Résumé

Des rapports hebdomadaires des facteurs de risque destinés à évaluer le cours du traitement ont été obtenus de la part d'enfants battus en âge scolaire et de leurs parents (ou figures parentales), qui avaient été assignés au hasard à un traitement comportemental-cognitif individuel enfant-parent (CBT) ou à une thérapie familiale (FT). Des mesures de la colère des parents, de la discipline/force physique et des problèmes familiaux ont été obtenues à chaque séance. Les mesures ont montré une stabilité modérée et une correspondance parent-enfant. Entre 20% et 23% des rapports des deux informateurs reconnaissaiènt des niveaux élevés de discipline/force physique pendant les premières et dernières phases du traitement. Encore un plus grand pourcentage de cas rapportaient plus de colère parentale et plus de problèmes familiaux. Les rapports des deux informateurs au début du traitement prédisaient les rapports de fin de traitement, seuls les rapports des parents étaient liés aux mesures de validités. Le niveau global de colère parentale et de discipline/force physique était plus bas dans les familles SBI, malgré le fait que les deux groupes de thérapie présentaient une dimunution de ces items tout au long des séances thérapeutiques. L'importance d'une évaluation de routine de l'évolution clinique d'un traitement est discutée, surtout pour l'identification des cas à risque de récidive.

Resumen

Se obtuvieron reportes semanales de indicadores de alto riesgo diseñados para supervisar el tratamiento de niños (as) fisicamente abusados, niños (as) de edad escolar y de sus padres/tutores; los que habian sido asignados al azar para recibir Tratamiento Individual Cognitivo-Conductual (TICC) ó Terapia Familiar (TF). Para cada sesión se obtuvieron medidas de ira parental, disciplina física/fuerza; y problemas familiares. Las medidas mostraron estabilidad moderada y correspondencia entre el padre y el hijo. Del 20% al 23% de los reportes presentados por los dos informantes, mostraron niveles altos de disciplina física/fuerza durante las etapas tempranas y posteriores del tratamiento; y un porciento aún mayor de casos, reportaron incremento en ira parental y problemas familiares. Los reportes de ambos informantes sobre los tratamientos predecían los reportes posterjores, pero solo los reportes de los padres estaban relacionados con las medidas de validez. Los niveles generales de ira parental y disciplina física/fuerza estaban más bajos en las familias de TICC que en las de TF, a pesar de que, en estos aspectos, ambos grupos mostraron una disminución de las sesiones iniciales a las posteriores. Se discute la importancia de una supervisión regular del curso clinico durante la intervención, especialmente en la identificación de casos en riesgo de re-abuso.

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    This study was supported by NCCAN Grant #90CA1459.

    ☆☆

    Portions of these data were presented at the 1994 annual meetings of the American Psychological Association (Toronto) and Association for the Advancement of Behavior Therapy (Atlanta).

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