Abuse Focused Cognitive Behavioral Therapy for Child Physical Abuse (AF-CBT) 

National Child Traumatic Stress Network 

www.NCTSN.org 

1 

 

Abuse-Focused Cognitive Behavioral Therapy for 

Child Physical Abuse 

(AF-CBT) 

 

Treatment 

Description 

• Acronym (abbreviation) for intervention: AF-CBT 

• Average length/number of sessions: The delivery of treatment is organized 

into three phases: 

• Phase 1: Joining with Family/Setting the Stage 

• Phase 2: Skills Building: Individual and Family 

• Phase 3: Applications: Family Routines 

Treatment generally involves 12 to 18 hours of service over a period of 12 to 

16 weeks and is applied in the clinic and home. Modalities of treatment have 

included parallel individual and family therapy sessions. Group treatment is 

also an option. 

• Aspects of culture or group experiences that are addressed (e.g., faith/spiritual 

component, or addresses transportation barriers): 

• Trauma type (primary): Physical abuse 

• Trauma type (secondary): 

• Additional descriptors (not included above): AF-CBT represents an approach to 

working with physically abused children and their offending caregivers that 

incorporates conceptual and therapeutic principles/procedures from several 

areas including learning/behavioral theory, family-systems, cognitive therapy, 

and developmental victimology. AF-CBT integrates several behavior therapy 

and CBT procedures that target individual child and parent characteristics 

related to the abusive experience and the larger family context in which 

coercion or aggression occurs. Thus, this approach can be used to address 

parent and family risks for/correlates of physical abuse and/or common 

sequelae exhibited by children following the abuse. Treatment emphasizes 

instruction in specific intrapersonal (e.g. cognitive, affective) and interpersonal 

(e.g. behavioral) skills designed to promote the expression of prosocial 

behavior and discourage the use of coercive/aggressive behavior at both the 

individual and family levels. For a detailed description, see Kolko, D.J., & 

Swenson, C.C. (2002), Assessing and treating physically abused children and 

their families: A cognitive behavioral approach. Thousand Oaks, CA: Sage 

Publications. 

 

 

Target 

Population 

• Age range: (lower limit) to (upper limit) School-age children 

• Gender: Males Females Both 

• Ethnic/Racial Group (include acculturation level/ immigration/refugee history--e.g., multinational 

sample of Latinos, recent immigrant Cambodians, multigenerational African Americans): 

• Other cultural characteristics (e.g., SES, religion) : 

• Language(s): 

• Region (.e.g., rural, urban): 

• Other characteristics (not included above): AF-CBT is appropriate for use with 

physically abusive/aggressive parents and their school-age children. Although 

it has been primarily used in outpatient settings, the treatment can be 
Abuse Focused Cognitive Behavioral Therapy for Child Physical Abuse (AF-CBT) 

National Child Traumatic Stress Network 

www.NCTSN.org 

2 

delivered on an individual basis in alternative residential settings, especially if 

there is some ongoing contact between caregiver and child. This approach is 

designed for caregivers who exhibit, for example, negative child perceptions, 

heightened anger or hostility, and/or harsh/punitive/ineffective parenting 

practices, or for families involved in verbally or physically coercive interactions. 

Related methods are designed for use with physically abused children who 

present with externalizing behavior problems, notably aggressive behavior, 

coping skills/adjustment problems, poor social competence, internalizing 

symptoms, and developmental deficits in relationship skills. Parents with 

serious psychiatric or personality impairments (e.g. substance use disorders, 

major depression,) may benefit from adjunctive and/or alternative 

interventions. In addition, children or parents with limited intellectual 

functioning, or very young children may benefit from more simplified services 

or translations of key concepts. Children with psychiatric disorders (e.g. 

Attention Deficit Hyperactivity Disorder, Major Depressive Disorder,) may 

benefit from additional interventions and traumatized children, especially 

sexually abused children, are more appropriate candidates for TraumaFocused CBT. 

Essential 

Components 

• Theoretical basis: Learning/behavioral theory, family-systems, cognitive 

therapy, and developmental victimology. 

• Key components: 

 

Child-directed components 

• Socialization to models of stress and CBT 

• Understanding and cognitive processing of the child’s exposure to 

hostility/violence and abusive experience(s) 

• Psycho education about child abuse laws, child safety/welfare, and 

common abuse-related reactions/attributions 

• Training in affect identification, expression, and management skills 

(e.g., relaxation training, anger control) 

• Coping skills discussions (healthy vs. unhealthy coping) and training 

to address everyday problems (e.g., home, school) 

• Development of social support plans and interpersonal skills 

training to enhance social competence 

Caregiver/Parent-directed components 

• Socialization to models of stress and CBT 

• Discussion of family contributors to coercive behaviors 

• Cognitive processing/challenging of caregiver’s views on 

hostility/violence, child-related developmental expectations, and 

attributions that may promote coercive interactions 

• Affect-regulation interventions to manage reactions to abusespecific triggers (e.g., escalating anger, anxiety, or depression) 

• Training in behavior management principles and techniques to 

promote use of nonphysical but effective disciplinary practices 

• As appropriate, discussion of or training in any of the procedures 

described in the child section above 
Abuse Focused Cognitive Behavioral Therapy for Child Physical Abuse (AF-CBT) 

National Child Traumatic Stress Network 

www.NCTSN.org 

3 

Parent-Child or family-system components 

• Development of no-violence contract and safety plans 

• Family assessment using multiple methods (rating scales, 

observations) and identification of family treatment goals 

• Clarification sessions to establish responsibility for the abuse, focus 

treatment on the needs of the victims/family, and develop safety 

and relapse prevention plans, as needed 

• Communication skills training to encourage constructive, supportive 

interactions 

• Nonaggressive problem-solving skills training to minimize coercion, 

with home practice applications to establish routines 

• Community and social system involvement, as needed 

 

 

Clinical & 

Anecdotal 

Evidence 

 

• Are you aware of any suggestion/evidence that this treatment may be 

harmful? Yes No Uncertain 

• Extent to which cultural issues have been described in writings about this 

intervention (scale of 1-5 where 1=not at all to 5=all the time). 

• This intervention is being used on the basis of anecdotes and personal 

communications only (no writings) that suggest its value with this group. 

Yes No 

• Are there any anecdotes describing satisfaction with treatment, drop-out rates 

(e.g., quarterly/annual reports)? Yes No 

If YES, please include citation: 

• Has this intervention been presented at scientific meetings? Yes No 

If YES, please include citation: 

• Are there any general writings which describe the components of the 

intervention or how to administer it? Yes No 

If YES, please include citation: 

Kolko, D.J. (1996a). Clinical monitoring of treatment course in child physical abuse: 

Psychometric characteristics and treatment comparisons. Child Abuse & 

Neglect, 20, 23-43. 

Kolko, D.J. (1996b). Individual cognitive-behavioral treatment and family therapy 

for physically abused children and their offending parents: A comparison of 

clinical outcomes. Child Maltreatment, 1, 322-342. 

Kolko, D.J. (2002). Child physical abuse. In J.E.B. Myers & L. Berliner & J. Briere & 

C.T. Hendrix & C. Jenny & T. Reid (Eds.), APSAC handbook of child 

maltreatment (Second ed., pp. 21-54). Thousand Oaks, CA: Sage 

Publications. 

Kolko, D.J., & Swenson, C.C. (2002). Assessing and treating physically abused 

children and their families: A cognitive behavioral approach. Thousand Oaks, 

CA: Sage Publications. 

• Has the intervention been replicated anywhere? Yes No 

 Other countries? (please list) 

• Other clinical and/or anecdotal evidence (not included above): Descriptions of 

the materials included in the book provide examples of their general 

application on an outpatient basis in addition to specific suggestions for cases 
Abuse Focused Cognitive Behavioral Therapy for Child Physical Abuse (AF-CBT) 

National Child Traumatic Stress Network 

www.NCTSN.org 

4 

that may require adaptations or special circumstances. Overall, the outcomes 

of these and related interventions have been fairly robust across different 

child and caregiver demographic background variables (e.g., age, gender, 

ethnicity, intellectual functioning, and family constellation.) However, specific 

applications to specific cultural groups or settings have not been formally 

reported. 

 

Research 

Evidence 

 

 

 Number of 

Participants 

Sample 

Breakdown 

Citation 

Published 

Case Studies 

Yes 

No 

N = By gender: 

By ethnicity: 

 

By other cultural 

factors: 

 

Pilot Trials/ 

Feasibility 

Trials (w/o 

control 

groups) 

Yes 

No 

N = By gender: 

By ethnicity: 

 

By other cultural 

factors: 

 

Clinical Trials 

(w/ control 

groups) 

Yes 

No 

N = By gender: 

By ethnicity: 

 

By other cultural 

factors: 

 

Randomized 

Control Trials 

Yes 

No 

N = By gender: 

By ethnicity: 

 

By other cultural 

factors: 

 

Studies 

describing 

modifications 

Yes 

No 

N = By gender: 

By ethnicity: 

 

By other cultural 

factors: 

 

Other 

research 

evidence 

Yes 

No 

N = By gender: 

By ethnicity: 

 

By other cultural 

factors: 

 

 

Outcomes 

 

• What assessments or measures are used as part of the intervention or for 

research purposes, if any? Several instruments may be used to evaluate 

factors in each of the following domains that may contribute to the risks for 

and/or consequences of child physical abuse (see Kolko & Swenson, 2002). 

An individualized assessment of this nature is encouraged to help the clinician 

better identify clinical targets for intervention: 

 

Caregiver parenting practices, including the use of coercive, aggressive, or violent 
Abuse Focused Cognitive Behavioral Therapy for Child Physical Abuse (AF-CBT) 

National Child Traumatic Stress Network 

www.NCTSN.org 

5 

behaviors (e.g., harsh physical discipline) and positive management practice: 

 A .Weekly Report of Abuse Indicators (WRAI; Kolko, 1996a) 

 B. Conflict Tactics Scales—Parent to Child version (CTSPC; Straus et al., 1998) 

 C. Alabama Parenting Questionnaire (APQ; Shelton et al., 1996) 

Child social skills, interpersonal effectiveness, social withdrawal: 

A. Child Behavior Checklist (CBCL; Achenbach, 1991) 

B. Social Skills Rating Scale (SSRS; Gresham and Elliot, 1990) 

Parental psychological distress and clinical targets 

A. Brief Symptom Inventory (BSI; Derogatis et al., 1983) 

B. Parent Opinion Questionnaire (POQ; Azar, 1986) 

Children’s behavioral and emotional problems 

A. Child Behavior Checklist (CBCL; Achenbach, 1991) 

B. Children’s Hostility Inventory (CHI; Kazdin et al., 1987) 

C. Trauma Symptom Checklist-Children (TSCC; Briere, 1996) 

Family functioning, especially levels of conflict and cohesion 

A. Family Environment Scale (FES; Moos et al., 1974) 

B. Family Adaptability Scales-II (FACES-II; Olson et al., 1982) 

• If research studies have been conducted, what were the outcomes? Outcome 

evaluation can include the use of any of the above listed measures for followup assessment across a variety of domains (caregiver practices, child 

emotional and behavioral problems, family cohesion/conflict, etc.). Other 

measures may be found in Kolko (2002). 

 

Some of the methods incorporated in AF-CBT have been found efficacious in 

outcome studies conducted with various populations of parents, children, and 

families over the past three decades (see Chalk and King, 1998; Kolko, 2002). 

The individual and family approaches in AF-CBT were evaluated relative to routine 

community services (RCS) in a clinical trial that evaluated key outcomes through a 

one-year follow-up assessment. In an initial analysis comparing the treatment 

course of the two randomized conditions (individual CBT vs. family therapy; see 

Kolko, 1996a,) weekly ratings of parents’ use of physical discipline/force and 

anger problems were found to decrease significantly faster among the individual 

child and parent CBT cases. In terms of overall outcomes through follow-up 

(Kolko, 1996b), both the individual CBT and family therapy conditions reported 

greater improvements than RCS on certain children (i.e., less child-to-parent 

aggression, child externalizing behavior,) parents (i.e., child abuse potential, 

individual treatment targets reflecting abusive behavior, psychological distress, 

drug use, and family outcomes (i.e., less conflict, more cohesion.) Both CBT and 

family therapy had high consumer satisfaction ratings. 

Implementation 

Requirements 

and Readiness 

• Space, materials or equipment requirements? Clinicians are encouraged to 

review the book and maintain copies of relevant materials for efficient use 

during sessions. It is also helpful to develop tapes for later review during 
Abuse Focused Cognitive Behavioral Therapy for Child Physical Abuse (AF-CBT) 

National Child Traumatic Stress Network 

www.NCTSN.org 

6 

supervision. Clinicians who reach integrity ratings of 75 percent with at least 

two cases should be adequately competent to administer the treatment. 

Having a confidential space for conducting sessions, access to clinical 

supervision, and a system for monitoring and responding to clinical 

emergencies are important aspects of a clinician’s general readiness for this 

work. 

• Supervision requirements (e.g., review of taped sessions)? 

• In order for successful implementation, support should be obtained from: 

Western Psychiatric Institute and Clinic, University of Pittsburgh School of 

Medicine 

 

Training 

Materials & 

Requirements 

• List citations for manuals or protocol descriptions and/or where manuals or 

protocol descriptions can be obtained. 

• How/where is training obtained? Training is intended for mental health 

professionals with at least some advanced training in psychotherapy 

skills/methods and experience working with physically abusive caregivers and 

their children. Participants are encouraged to review a brief summary of the 

treatment approach beforehand; whenever possible, it is desirable to become 

familiar with the materials in the author’s book, which provides more detail on 

assessment and treatment methods. In addition, a pretraining assessment 

survey has been administered to gain an understanding of therapist’s 

practices and knowledge. Training generally involves at least six hours of 

didactic instruction. We strongly advise additional training experiences, 

including follow-up consultation and supervision on the implementation of AFCBT with a small caseload; the duration of this experience may vary by level of 

experience and case difficulty (typical range: six to 18 hours over three to six 

mos.) 

• What is the cost of training? 

• Are intervention materials (handouts) available in other languages? 

Yes No 

If YES, what languages? 

• Other training materials &/or requirement (not included above): 

 

Pros & Cons/ 

Qualitative 

Impressions 

 

• What are the pros of this intervention over others for this specific group (e.g., 

addresses stigma re. treatment, addresses transportation barriers)? 

• What are the cons of this intervention over others for this specific group (e.g., 

length of treatment, difficult to get reimbursement)?: 

• Other qualitative impressions: Based on independent supervisor ratings from 

the author’s original clinical trial (Kolko, 1996a), high levels of therapeutic 

integrity have been found among trained master’s-level clinicians who have 

conducted individual CBT (81 percent) and family treatment (85 percent). A 

simplified version of this integrity checklist for community application is being 

developed by the author. 

 

Contact 

Information 

 

Name: David J. Kolko, PhD 

Address: University of Pittsburgh, School of Medicine 

Phone number: (412) 246-5888 

Email: kolkodj@upmc.edu 

Website: www.pitt.edu/~kolko 
Abuse Focused Cognitive Behavioral Therapy for Child Physical Abuse (AF-CBT) 

National Child Traumatic Stress Network 

www.NCTSN.org 

7