Treatment-as-Usual for Child Physical Abuse in Community Mental Health Centers: Therapist Characteristics, Client Profiles, and Therapy Processes

Abstract

There is a growing emphasis on utilizing evidence-based treatments in community settings; yet little is known about treatment practices in usual care. The first aim of this study sought to describe treatment-as-usual (TAU) for children at risk of physical abuse, and identify elements of one evidence-based treatment, Alternatives for Families: A Cognitive Behavior Therapy (AF-CBT), present in usual care. A second aim was to identify how contextual variables influenced treatment practices. Participants included 44 practitioners and 64 families that presented with concerns of risk of physical abuse. The Therapy Process Observational Coding System for Child Psychotherapy–Strategies Scale and AF-CBT Adherence Coding System were used to understand treatment practices in 278 therapy sessions. Similar to other studies on TAU, families received treatment for an extensive time ( M = 19 sessions), and practitioners delivered a wide array of therapeutic techniques and some elements of AF-CBT; however, they did not utilize many techniques in great depth. An analysis of contextual factors indicated that there was variation based upon agency, practitioner, and family characteristics in the delivery of treatment practices. These findings are an important step in understanding treatment practices and contextual influences on usual care for children at risk of physical abuse.