PITTSBURGH, August 26, 1998 — The results of two new studies completed at the University of Pittsburgh Medical Center’s (UPMC) Western Psychiatric Institute and Clinic may help community organizations that provide services to abused children and their families reevaluate the types of therapy they provide, said David J. Kolko, Ph.D., associate professor of child psychiatry and psychology and a nationally recognized expert on child abuse.
The Pittsburgh Service Delivery Study was designed to document the service delivery experiences and outcomes of 90 families referred to Child Protective Services (CPS) following an allegation of child physical or sexual abuse. Measures included CPS risk assessments, interviews with child victims and their parents to evaluate client outcomes and family satisfaction with services, and community service provider reports.
In his initial report from this study published in the latest issue of Child Maltreatment, Dr. Kolko found that risk assessment and related evaluations were generally conducted on time, but they were occasionally completed well beyond suggested deadlines. Reports based on the caseworkers’ risk assessment were not found to be related to clinical measures of individual or family functioning based on child and parent reports. Compared to physically abused children, sexually abused children had higher rates of nonparent perpetrators, police reports, official substantiation, and ratings of the severity of their incidents.
In the second report from that study, Dr. Kolko and his colleagues examined the services received by abused children and their families. They found that less than 20 percent of the children received individual treatment, while more than 50 percent of the parents or families received treatment. Some of these services were more common depending upon the type of abuse. For example, sexually abused children more often received individual services, whereas physically abused more often participated in family services.
"These findings will hopefully contribute to our understanding of some of the operations of CPS agencies and suggestions for enhancing their role in the service delivery system developed for abused children and their families," commented Dr. Kolko.
One recent advance in helping the abusive family is the development and evaluation of specialized treatments. In one of the few federally funded outcome studies with school-aged physically abused children and their offending caregivers, Dr. Kolko and his colleagues found that structured, treatment protocols conducted at UPMC were effective in reducing parental anger and use of physical force. The results, published in Child Maltreatment with a sample of 55 families, indicated that individual skills-based therapy or family therapy showed better improvement on several outcomes, such as parental abuse risk and family conflict, than families who received routine services elsewhere in the community.
These individual and family treatments were designed to be similar in several ways. Both interventions followed treatment manuals that included content for use in the clinic and during follow-up home visits; were administered in at least 12, one-hour weekly clinic sessions within a 16-week period, for a total of about 18 hours of service; and included structured supervision meetings and ongoing ratings of client involvement and performance.
"Studies like this one are needed because there have been relatively few rigorous evaluations of short-term treatments directed towards physically abused children and their offending parents or families," explained Dr. Kolko. "Because abused children can suffer long-term emotional and behavioral problems, we need to have an understanding of the types of therapies that work best to reduce the after-effects of an abusive experience and to try to prevent future episodes of family violence. Our data show that some therapies may work better than others in limiting additional violence and improving family adjustment."