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ISSUE BRIEF

January 2013

Use your smartphone to 

access this issue brief online.

Alternatives for 

Families: A CognitiveBehavioral Therapy 

(AF-CBT)

• What makes AF-CBT 

unique? 

• Treatment phases and key 

components

• Target population

• Effectiveness of AF-CBT

• What to look for in a 

therapist

• Resources for more 

information

What’s Inside:

Families that experience conflict, coercion,1 and/

or physical abuse create substantial risk to children 

for the development of significant psychiatric, 

behavioral, and adjustment difficulties, including 

aggression, poor interpersonal skills/functioning, 

and emotional reactivity. Caregivers in such families 

often report punitive or excessive parenting practices, 

frequent anger and hyperarousal, and negative child 

attributions, among other stressful conditions. During 

the past four decades, research has documented 

the effectivenss of several behavioral and cognitivebehavioral methods, many of which have been 

1	 Coercive parenting refers to parenting by domination, intimidation,

or humiliation to force children to behave according to (often unrealistic)

norms set by parents.
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incorporated in alternatives for families: a 

cognitive-behavioral therapy (AF-CBT). 

AF-CBT is an evidence-supported intervention 

that targets (1) diverse individual child and 

caregiver characteristics related to conflict 

and intimidation in the home and (2) the 

family context in which aggression or abuse 

may occur. This approach emphasizes training 

in intra- and interpersonal skills designed 

to enhance self-control and reduce violent 

behavior. AF-CBT has been found to improve 

functioning in school-aged children, their 

parents (caregivers), and their families 

following a referral for concerns about 

parenting practices, including child physical 

abuse (Kolko, 1996a; Kolko, 1996b; Kolko, 

Iselin, & Gully, 2011), as well as a child’s 

behavior problems (Kolko, et al., 2009; Kolko, 

Hoagwood, & Springgate, 2010; Kolko, 

Campo, Kilbourne, & Kelleher, 2012). 

This issue brief is intended to build a better 

understanding of the characteristics and 

benefits of AF-CBT, formerly known as abusefocused cognitive behavioral therapy (Kolko, 

2004). It was written primarily to help child 

welfare caseworkers and other professionals 

who work with at-risk families make more 

informed decisions about when to refer 

children and their parents and caregivers 

to AF-CBT programs. This information also 

may help parents, foster parents, and other 

caregivers understand what they and their 

children can gain from AF-CBT and what to 

expect during treatment. In addition, this issue 

brief may be useful to others with an interest 

in implementing or participating in effective 

strategies for the treatment of family conflict, 

child physical abuse, coercive parenting, and 

children with externalizing behavior problems. 

What Makes AF-CBT Unique?

AF-CBT is designed to intervene with families 

referred for conflict or coercion, verbal or 

physical aggression by caregivers (including 

the use of excessive physical force or threats), 

behavior problems in children/adolescents, or 

child physical abuse. The treatment program 

has been expanded to accommodate children 

and adolescents with physical abuse or 

discipline-related trauma symptoms, such as 

posttraumatic stress disorder (PTSD). 

AF-CBT addresses both the risk factors and 

the consequences of physical, emotional, 

and verbal aggression in a comprehensive 

manner. Thus, AF-CBT seeks to address 

specific clinical targets among caregivers that 

include heightened anger or hostility, negative 

perceptions or attributions of their children, 

and difficulties in the appropriate and effective 

use of parenting practices, such as ineffective 

or punitive parenting practices. Likewise, 

AF-CBT targets children’s difficulties with 

anger or anxiety, trauma-related emotional 

symptoms, poor social and relationship skills, 

behavioral problems that include aggression, 

and dysfunctional attributions. At the family 

level, AF-CBT addresses coercive family 

interactions by teaching skills to improve 

positive family relations and reduce family 

conflict.

Reflects a Comprehensive 

Treatment Strategy

The diversity of family circumstances 

and individual problems associated with 

family conflict points to the need for a 

comprehensive treatment strategy that targets 

both the contributors to caregivers’ behavior 
Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT)

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and children’s subsequent behavioral and 

emotional adjustment (Chadwick Center, 

2004). Treatment approaches that focus on 

several aspects of the problem (for example, 

a caregiver’s parenting skills, a child’s 

anger, family coercion) may have a greater 

likelihood of reducing re-abuse and more fully 

remediating mental health problems (Kolko 

& Swenson, 2002). Therefore, AF-CBT adopts 

a comprehensive treatment strategy that 

addresses the complexity of the issues more 

completely.

Integrates Several 

Therapeutic Approaches

AF-CBT combines elements drawn from the 

following:

• Cognitive therapy, which aims to change 

behavior by addressing a person’s thoughts 

or perceptions, particularly those thinking 

patterns that create distorted views 

• Behavioral and learning theory, which 

focuses on modifying habitual responses 

(e.g., anger, fear) to identified situations or 

stimuli

• Family therapy, which examines patterns 

of interactions among family members to 

identify and alleviate problems, and offers 

strategies to help reframe how problems 

are viewed 

• Developmental victimology, which 

describes how the specific effects 

of exposure to traumatic or abusive 

experiences may vary for children at 

different developmental stages and across 

the life span

• Psychology of aggression, which describes 

the processes by which aggression and 

coercion develop and are maintained, 

which can help to understand one’s history 

as both a contributor to and victim of 

aggressive behavior

AF-CBT pulls together many techniques 

currently used by practitioners, such as 

behavior and anger management, affect 

regulation, problem-solving, social skills 

training, cognitive restructuring, and 

communication. The advantage of this 

program is that all of these techniques, 

relevant handouts, training examples, and 

outcome measures are integrated in a 

structured approach that practitioners and 

supervisors can easily access and use. 

Treats Children and Parents 

Simultaneously 

During AF-CBT, school-aged children (5-15) 

and their caregivers participate in separate 

but coordinated therapy sessions, often using 

somewhat parallel treatment materials. In 

addition, children and parents attend joint 

sessions together at various times throughout 

treatment. This approach seeks to address 

individual and parent-child issues in an 

integrated fashion. 

Discourages Aggressive or 

Violent Behavior

The AF-CBT approach is designed to 

promote appropriate and prosocial behavior, 

while discouraging coercive, aggressive, or 

violent behavior from caregivers as well as 

children. Consistent with cognitive-behavioral 

approaches, AF-CBT includes procedures 

that target three related ways in which people 

respond to different circumstances:

• Cognition (thinking) 

• Affect (feeling) 

• Behavior (doing)

3
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AF-CBT includes training in various 

psychological skills in each of these response 

channels that are designed to promote 

self-control and to enhance interpersonal 

effectiveness. 

Tailors Treatment to Meet Specific 

Needs and Circumstances

AF-CBT begins with a multisource assessment 

to identify the nature of the problems the child 

is experiencing, specific parental and family 

difficulties that may be contributing to family 

conflict, and the child’s and family’s strengths 

that may help influence change. Tailoring the 

treatment to the family’s specific strengths and 

challenges is key to efficient outcomes (Kolko 

& Swenson, 2002). 

Treatment Phases and Key 

Components

AF-CBT is a short-term treatment typically 

provided once or twice a week, which may 

require 18 to 24 hours of service (or longer, 

based on individual needs) over 4 to 12 

months (although treatment may last as long 

as determined necessary). Treatment includes 

separate individual sessions with the child and 

caregiver/parent and joint sessions with at 

least both of them. Where necessary, family 

interventions may be applied before, during, 

or after the individual services. The treatment 

program for children, caregivers, and families 

incorporates the use of specific skills, roleplaying exercises, performance feedback, and 

home practice exercises. 

Generally, the goals of AF-CBT treatment are 

to:

• Reduce conflict and increase cohesion in 

family 

• Reduce use of coercion (hostility, anger, 

verbal aggression, threats) by the caregiver 

and other family members

• Reduce use of physical force (aggressive 

behavior) by the caregiver, child, and, as 

relevant, other family members 

• Promote nonaggressive (alternative) 

discipline and interactions

• Reduce child physical abuse risk or 

recidivism (prevention of child welfare 

system involvement or repeated reports/

allegations)

• Improve the level of child’s safety/welfare 

and family functioning

Treatment Phases 

AF-CBT includes three treatment phases, 

each with key content that is designed 

to be relevant for both the caregiver and 

child. The sequence for conducting the 

treatment generally proceeds from teaching 

intrapersonal (e.g., cognitive, affective) 

skills first, followed by interpersonal skills 

(e.g., behavioral). Topics/sessions can be 

flexibly delivered (adapted, abbreviated, or 

repeated) based on the family’s progress 

and/or treatment needs/goals in each phase. 

Although AF-CBT has primarily been used in 

outpatient and home settings, the treatment 

has been more recently delivered in inpatient 

and residential settings when there is some 

ongoing or potential contact between the 

caregiver and the child. The primary content 

in each topic noted below is organized 

into three phases reflected in the acronym 

A-L-T-E-R-N-A-T-I-V-E-S.
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PHASE I: ENGAGEMENT and 

PSYCHOEDUCATION

• TOPIC 1: Orientation–Caregiver and Child

• TOPIC 2: Alliance Building and 

Engagement–Caregiver

• TOPIC 3: Learning About Feelings and 

Family Experiences–Child 

• TOPIC 4: Talking About Family Experiences 

and Psychoeducation–Caregiver

PHASE II: INDIVIDUAL SKILL-BUILDING 

(Skills Training)

• TOPIC 5: Emotion Regulation–Caregiver

• TOPIC 6: Emotion Regulation–Child

• TOPIC 7: Restructuring Thoughts–Caregiver

• TOPIC 8: Restructuring Thoughts–Child

• TOPIC 9: Noticing Positive 

Behavior–Caregiver

• TOPIC 10: Assertiveness and Social 

Skills–Child

• TOPIC 11: Techniques for Managing 

Behavior–Caregiver

• OPTIONAL TOPIC 12: Imaginal 

Exposure–Child

• TOPIC 13: Preparation for 

Clarification–Caregiver

PHASE III: FAMILY APPLICATIONS

• TOPIC 14: Verbalizing Healthy 

Communication–Caregiver and Child 

• TOPIC 15: Enhancing Safety Through 

Clarification–Caregiver and Child

• TOPIC 16: Solving Family Problems–

Caregiver and Child

• TOPIC 17: Graduation–Caregiver and Child

Key Components 

AB-CBT includes specific therapy elements for 

children, parents, and families.

Treatment for School-Aged Children. The 

school-aged child-directed therapy elements 

include:

• Promoting engagement and treatment 

motivation by identifying individualized 

goals

• Identifying the child’s exposure to and 

views of positive experiences and upsetting 

ones (family hostility, coercion, and 

violence), including the child’s perceptions 

of the circumstances and consequences of 

the physical abuse or other conflict

• Educating the child on topics related to 

child welfare, safety/protection, service 

participation, and common reactions to 

abuse and family conflict

• Training in techniques to identify, express, 

and manage emotions appropriately (e.g., 

anxiety management, anger control)

• Processing the child’s exposure to incidents 

involving force or family conflict to 

understand and challenge any dysfunctional 

thoughts/views that encourage the use of 

aggression or support self-blame for these 

situations

• Training in interpersonal skills to enhance 

social competence and developing social 

support plans 

• For those with significant PTS symptoms, 

conducting imaginal exposure and helping 

to articulate the meaning of what happened 

to the child 
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Treatment for Parents (or Caregivers).

Parent-directed therapy elements include:

• Education about relevance of the CBT 

model and physical abuse

• Establishing a commitment to limit physical 

force 

• Encouraging discussion of any incidents 

involving the use of force within the family

• Reviewing the child’s exposure to emotional 

abuse in the family and providing 

education about the parameters of abusive 

experiences (causes, characteristics, and 

consequences) in order to understand the 

context in which they occurred

• Teaching affect management skills to help 

identify and manage reactions to abusespecific triggers, heightened anger, anxiety, 

and depression to promote self-control

• Identifying and addressing cognitive 

contributors to abusive behavior 

in caregivers (i.e., misattributions, 

high expectations, etc.) and/or their 

consequences in children (i.e., views 

supportive of aggression, self-blame, etc.) 

that could maintain any physically abusive 

or aggressive behavior

• Teaching parents strategies to support 

the child and encourage positive behavior 

using active/listening attention, praise, and 

rewards 

• Training in effective discipline guidelines 

and strategies (e.g., planned ignoring, 

withdrawal of privileges, time out,) as 

alternatives to the use of physical force 

• If the caregiver is ready, working on a 

clarification letter to be read to the child

Treatment for Families (or the Parent and 

Child). Parent-child or family therapy elements 

include:

• Conducting a family assessment using 

multiple methods and identifying family 

treatment goals

• Encouraging a commitment to increasing 

the use of positive behavior as an 

alternative to the use of force 

• Conducting a clarification session in which 

the caregiver can support the child by 

providing an apology, taking responsibility 

for the abuse/conflict, and showing a 

commitment to safety plans and other rules 

in order to keep the family safe and intact 

• Training in communication skills to 

encourage constructive interactions

• Training in nonaggressive problem-solving 

skills with home practice applications

• Involving community and social systems, as 

needed

Target Population

AF-CBT is most appropriate for use with 

physically, emotionally, and/or verbally abusive 

or coercive parents and their school-aged 

children (Kolko, 1996a; Kolko, 1996b). AF-CBT 

has also been adapted for children diagnosed 

with behavior problems or disorders, including 

conduct disorder and oppositional defiant 

disorder (Kolko, Dorn, et al., 2009). Often, the 

children experience behavioral dysfunction, 

especially aggression, as a result of abuse. 

AF-CBT may also help high-conflict families 

who are at-risk for physical abuse/aggression.
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Thus, AF-CBT is recommended for use with 

families that exhibit any or all of the following:

• Caregivers whose disciplinary or 

management strategies range from mild 

physical discipline to physically aggressive 

or abusive behaviors, or who exhibit 

heightened levels of anger, hostility, or 

explosiveness 

• Children who exhibit significant 

externalizing or aggressive behavior (e.g., 

oppositionality, antisocial behavior), with or 

without significant physical abuse/discipline 

related trauma symptoms (e.g., anger, 

anxiety, PTSD) 

• Families who exhibit heightened conflict or 

coercion or who pose threats to personal 

safety 

Limitations for Use of AF-CBT 

Parents with psychiatric disorders that may 

significantly impair their general functioning or 

their ability to learn new skills (e.g., substance 

use disorders, major depression) may benefit 

from alternative or adjunctive interventions 

designed to address these problems 

(Chadwick Center, 2004). In addition, children 

or parents with very limited intellectual 

functioning, or very young children, may 

require more simplified services or translations 

of some of the more complicated treatment 

concepts. Children with psychiatric disorders 

such as significant attention-deficit disorder or 

major depression may benefit from additional 

interventions. Sexually abused children may 

respond better to trauma-focused therapy. 

For more information, see Child Welfare 

Information Gateway’s Trauma-Focused 

Cognitive Behavioral Therapy for Children 

Affected by Sexual Abuse or Trauma: https://

www.childwelfare.gov/pubs/trauma. 

Effectiveness of AF-CBT

The effectiveness of AF-CBT is supported by 

a number of outcome studies, and AF-CBT 

has been recognized by other experts as a 

“model” or “promising” treatment program. 

Demonstrated Effectiveness 

in Outcome Studies

During the past four decades, many of the 

procedures incorporated into AF-CBT have 

been evaluated by outside investigators as 

effective in:

• Improving child, parent, and/or family 

functioning

• Promoting safety and/or reducing abuse 

risk or re-abuse among various populations 

of parents, children, and families

These procedures have included the use 

of stress management and anger-control 

training, cognitive restructuring, parenting 

skills training, psychoeducational information 

regarding the use and impact of physical force 

and hostility, social skills training, imaginal 

exposure, and family interventions focusing 

on reducing conflict (see Kolko, 2002; Kolko & 

Kolko, 2009; Urquiza & Runyon, 2010).

Foundational studies by Kolko (1996a, 1996b) 

showed the effectiveness of the individual 

components of AF-CBT when compared 

to routine community services with abusive 

families in terms of improved child, parent, 

and family outcomes. A more recent study 

by Kolko, Iselin, and Gully (2011) documents 

the sustainability and clinical benefits of 

AF-CBT in an existing community clinic serving 

physically abused children and their families. 
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Key AF-CBT outcomes from the literature are 

summarized in the exhibit on the next page.

Recognition as an EvidenceBased Practice 

Based on systematic reviews of available 

research and evaluation studies, several 

groups of experts and agencies have 

highlighted AF-CBT as a model program or 

promising treatment practice: 

• AF-CBT is rated a 3, which is a Promising 

Practice, by the California Evidence-Based 

Clearinghouse for Child Welfare (http://

www.cebc4cw.org). 

• AF-CBT is featured in the Chadwick 

Center’s (2004) Closing the Quality Chasm 

in Child Abuse Treatment: Identifying 

and Disseminating Best Practices (http://

www.chadwickcenter.org/Documents/

Kaufman%20Report/ChildHospNCTAbrochure.pdf). 

• AB-CBT is featured in Trauma-Informed 

Interventions: Clinical and Research 

Evidence and Culture-Specific Information 

Project, published by the National Child 

Traumatic Stress Network and the Medical 

University of South Carolina (de Arellano, 

Ko, Danielson, & Sprague, 2008).

• It is approved as an evidence-based 

treatment (EBT) by the Los Angeles County 

Office of Mental Health. 

• It is included in EBT dissemination efforts 

being conducted by the Effective Providers 

for Child Victims of Violence Program of 

the American Psychological Association 

(http://www.apa.org/pi/prevent-violence/

programs/child-victims.aspx). 

• AF-CBT is included as a promising EBT in 

the website maintained by the U. S. Office 

of Justice Programs (http://crimesolutions.

gov/ProgramDetails.aspx?ID=107). 

• It is included in EBT dissemination activities 

by the Defending Childhood Initiative 

sponsored by the Attorney General’s Office, 

U. S. Department of Justice.

• It is currently being disseminated by 

the National Child Traumatic Stress 

Network (NCTSN) in a National Learning 

Collaborative on AF-CBT. 

What to Look for in a Therapist

Caseworkers who are considering a 

family’s referral for AF-CBT should become 

knowledgeable about commonly used 

treatments before recommending a treatment 

provider to families. Parents or caregivers 

should receive as much information as 

possible on the treatment options available 

to them. If AF-CBT appears to be an 

appropriate treatment model for a family, the 

caseworker should look for a provider who 

has received adequate training, supervision, 

and consultation in the AF-CBT model. If 

feasible, both the caseworker and the family 

should have an opportunity to interview 

potential AF-CBT therapists prior to beginning

treatment. AF-CBT can be provided in 

multiple settings—in the home, in clinics, or 

other community settings—and the average 

length of services varies depending on the 

client’s needs, goals, and progress. Relevant 

information may also be available on the 

AF-CBT website (http://www.afcbt.org). 
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Summary of AF-CBT Outcomes

Parent Outcomes

• Achievement of individual treatment goals related to the use of more effective discipline 

methods

• Decreased parental reports of overall psychological distress 

• Lowered parent-reported child abuse potential (risk) 

• Reduction in parent-reported drug use

Child Outcomes

• Reduction in parent-reported severity of children’s behavior problems (externalizing 

behavior), including child-to-parent aggression and likelihood of violating other children’s 

privacy

• Reduction in child anxiety

• Greater child safety from harm 

Family Outcomes

• Greater child-reported family cohesion 

• Reduced child-reported and parent-reported family conflict

Child Welfare Outcome

• Low rate of abuse recidivism or concerns about the child being harmed

AF-CBT Training 

Mental health professionals with at least some 

advanced training in psychotherapy skills 

and methods and experience working with 

physically abusive caregivers and their children 

are eligible for training in AF-CBT. Training 

generally involves: 

• An initial didactic workshop training (3 days)

• Follow-up case consultation calls during 

“action plan” periods (6-12 months)

• Review of session performance samples for 

integrity/competency 

• Booster retraining and advanced case 

review (1 day) 

• Review of community metrics and progress 

report

See Training and Consultation Resources, 

below, for contact information.

Questions to Ask Treatment 

Providers 

In addition to appropriate training and 

thorough knowledge of the AF-CBT model, 

it is important to select a treatment provider 

who is sensitive to the particular needs of 
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the child, caregiver, and family. Caseworkers 

recommending an AF-CBT therapist should 

ask the treatment provider to explain the 

course of treatment, the role of each family 

member in treatment, and how the family’s 

specific cultural considerations will be 

addressed. The child, caregiver, and family 

should feel comfortable with and have 

confidence in the therapist.

Some specific questions to ask regarding 

AF-CBT include: 

• Will the child and parent each receive 

individualized therapy using corresponding 

(coordinated) treatment protocols?

• Will social learning principles be used 

to address the thoughts, emotions, and 

behaviors of the child and parent?

• Is there a focus on enhancing the parentchild relationship and improving parental 

discipline practices?

• Is the practitioner sensitive to the cultural 

background of the child and family?

• Is there a standard assessment process 

used to gather baseline information on the 

functioning of the child and family and to 

monitor their progress in treatment over 

time?

• Is this the most appropriate treatment for 

this child and family?

Conclusion

AF-CBT is an evidence-supported treatment 

intervention for parents and school-aged 

children in families in which physical, 

emotional, or verbal abuse or family conflict 

has occurred. AF-CBT uses an integrated 

approach to address beliefs about abuse 

and violence and improve skills to enhance 

emotional control and reduce violent behavior. 

Improvements resulting from the use of 

AF-CBT include reductions in the risk of 

child abuse, fewer abuse-related behavior 

problems in children, and improvements 

in family cohesion. Increased awareness of 

this treatment option among those making 

referrals, coupled with increased availability, 

may create opportunities for helping to 

strengthen families and reduce the risks for 

and consequences of child physical abuse.

Resources for More Information

References 

Chadwick Center. (2004). Closing the quality 

chasm in child abuse treatment: Identifying 

and disseminating best practices. San 

Diego, CA: Author. Retrieved from 

http://chadwickcenter.org/Documents/

Kaufman%20Report/ChildHospNCTAbrochure.pdf

de Arellano, M. A., Ko, S. J., Danielson, C. K., 

& Sprague, C. M. (2008). Trauma-informed 

interventions: Clinical and research 

evidence and culture-specific information 

project. Los Angeles, CA, & Durham, NC: 

National Center for Child Traumatic Stress. 

Kolko, D. J. (1996a). Individual cognitivebehavioral treatment and family therapy 

for physically abused children and their 

offending parents: A comparison of clinical 

outcomes. Child Maltreatment: Journal of 

the American Professional Society on the 

Abuse of Children, 1, 322–342. 
Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT)

11 This material may be freely reproduced and distributed. However, when doing so, please credit Child 

Welfare Information Gateway. Available online at https://www.childwelfare.gov/pubs/cognitive/

https://www.childwelfare.gov

Kolko, D. J. (1996b). Clinical monitoring of 

treatment course in child physical abuse: 

Psychometric characteristics and treatment 

comparisons. Child Abuse & Neglect, 20(1), 

23–43.

Kolko, D. J. (2004). Individual child and 

parent physical abuse-focused cognitivebehavioral treatment. In B. E. Saunders, 

L. Berliner, & R. F. Hanson (Eds.), Child 

Physical and Sexual Abuse: Guidelines 

for Treatment (pp. 43–44). Charleston, 

SC: National Crime Victims Research and 

Treatment Center.

Kolko, D. J., Campo, J. V., Kelleher, K., & 

Cheng, Y. (2010). Improving access to 

care and clinical outcomes for pediatric 

behavioral problems: A randomized trial 

of a nurse-administered intervention in 

primary care. The Journal of Behavioral and 

Developmental Pediatrics, 31(5), 393–404.

Kolko, D. J., Campo, J. V., Kilbourne, A., 

& Kelleher, K. (2012). Doctor-office 

collaborative care for pediatric behavior 

problems: A preliminary clinical trial. 

Archives of Pediatrics & Adolescent 

Medicine, 166, 224–231. 

Kolko, D. J., Dorn, L. D., Bukstein, O. G., 

Pardini, D., Holden, E. A., & Hart, J. D. 

(2009). Community vs. clinic-based modular 

treatment of children with early-onset 

ODD or CD: A clinical trial with threeyear follow-up. Journal of Abnormal Child 

Psychology, 37, 591–609. 

Kolko, D. J., Hoagwood, K., & Springgate, 

B. (2010). Treatment research for trauma/

PTSD in children and youth: Moving from 

efficacy to effectiveness. General Hospital 

Psychiatry, 32(5):465–76.

Kolko, D. J., Iselin, A. M., & Gully, K. (2011). 

Evaluation of the sustainability and clinical 

outcome of alternatives for families: A 

cognitive-behavioral therapy (AF-CBT) in 

a child protection center. Child Abuse & 

Neglect, 35(2), 105–116. 

Kolko, D. J., & Kolko, R. P. (2009). 

Psychological impact and treatment of 

child physical abuse of children. In C. Jenny 

(Ed.), Child Abuse and Neglect: Diagnosis, 

Treatment and Evidence (pp. 476–489). 

Philadelphia: Saunder/Elsevier, Inc.

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.

Urquiza, A., & Runyon, M. (2010). Interventions 

for physically abusive parents and abused 

children. In J. E. B. Myers (Ed.), The 

APSAC Handbook on Child Maltreatment

(3rd edition). Thousand Oaks, CA: SAGE 

Publications. 

Training and Consultation Resources

David J. Kolko, Ph.D., A.B.P.P.

Director, Special Services Unit

Western Psychiatric Institute and Clinic, 

University of Pittsburgh School of Medicine

541 Bellefield Towers

Pittsburgh, PA 15213

412.246.5888 

kolkodj@upmc.edu 

Website: http://www.afcbt.org
Alternatives for Families: A Cognitive-Behavioral Therapy (AF-CBT) https://www.childwelfare.gov

Clinicians are encouraged to read the 

following book:

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. (Available from 

http://www.sagepub.com)

The latest AF-CBT session guide and handouts 

(version 3; 11-1-2011) are described on the 

AF-CBT website (http://www.afcbt.org), which 

also includes training opportunities and 

research updates.

Acknowledgment: This issue brief was 

developed by Child Welfare Information 

Gateway, in partnership with the Chadwick 

Center for Children and Families at Rady 

Children’s Hospital-San Diego. Contributing 

authors include David Kolko, Ph.D, ABPP; 

Daniel Kleiner, Psy.D.; Barbara Baumann, 

Ph.D.; and Charles Wilson, M.S.S.W. This 

document is made possible by the Children’s 

Bureau, Administration on Children, Youth 

and Families, Administration for Children 

and Families, U.S. Department of Health and 

Human Services. The conclusions discussed 

here are solely the responsibility of the authors 

and do not represent the official views or 

policies of the funding agency. The Children’s 

Bureau does not endorse any specific 

treatment or therapy.

Suggested Citation: 

Child Welfare Information Gateway. (2013). 

Alternatives for families: A cognitivebehavioral therapy (AF-CBT). Washington, 

DC: U.S. Department of Health and Human 

Services, Children’s Bureau.

U.S. Department of Health and Human Services

Administration for Children and Families

Administration on Children, Youth and Families

Children’s Bureau