Nursing 450: Research Synthesis Paper

1.Table of Evidence
PICO: P: pediatric physical abuse trauma patients
I: individual therapy
C: group therapy
O: augmented recovery

The Effect of Multifocal Therapy Modalities on a Childs Recovery from Physical Abuse

Author, Year,

Study Purpose

Sample

Intervention

Instruments

Results/Findings

Conclusion

To describe the different

N=250

None

Group therapy

males

Questionnaires
Reliability/Validity was

There are seven types of turning

types of turning points in

points that can be classified into

provided meaningful

established

three major categories:

relationships that can

influential relationships, insights

augment recovery

and new meanings, and action

and be considered a

oriented communication.

turning point in the

LOE
Easton et al.,
2015

males survivors of abuse

LOE 5

recovery process.
Ehring et al.,
2014

The effectiveness of

N=16

Trauma focused

PTSD treatment in

studies

CBT

None

Trauma focused interventions

were more effective than non-

childhood abuse survivors

trauma focused interventions.

LOE 1

Child abuse survivors

with PTSD respond
better to trauma
focused
CBT and group
therapy alone is not
as effective as
therapy integrating
individual sessions

Hubel et al.,
2014

Strengthen social and

N=97

family relationships in

children

Group sessions

children suffering from

LOE 4

Trauma Symptom Checklist

for Children
Reliability/Validity was
established

sexual abuse through CB-

The improvement in TSCC

This group treatment

scores for each participant

study proved

ranged from 1035 points higher

significant reduction

than their initial score.

in the negative

GT

consequences related
to child abuse.

Kjellgren et al.,
2013

Evaluate the treatment

N=18

CPC CBT a

effect of the CPCCBT

families

16 session
program

LOE 4

Trauma Symptom
checklist for children, Beck
Depression Inventory for
parents,
KSADS,
Reliability/Validity was

Significantly decreased

Shows the benefits of

symptoms of depression among

individual

parents, less use of violent

specifically CPCCBT

parenting strategies and less

in physical abuse

inconsistent parenting. Trauma

children and parents.

established

symptoms and depression

among children were
significantly reduced.

Kolko, 1996

LOE 2

To compare the

N=55

treatment outcomes

children

between individual
parent and child therapy
and group therapy

Individual
child and
parent
cognitive
behavioral
therapy
(CBT) and

None

family therapy

Family therapy showed a

Both group and

greater reduction in child

individual therapy

reported parent to child

can augment

violence and both family

recovery, improve

therapy and individual

family functioning

therapy showed a decrease

and decrease the

in parent reported violence.

risk of repeated

(FT)
McMullen et
al., 2013

The efficacy of Trauma

Focused Cognitive
Behavioral Therapy

LOE 2

(TFCBT) on child soldiers

and war affected children.

N=100 boys

Group based,
culturally
adapted
(TFCBT)

physical abuse.
Assessment interview
Reliability/Validity was not
established

Compared to the control group,

the group based
TFCBT intervention saw a
significant reduction in post
traumatic stress symptoms and
an increase in prosocial
behavior

The group based

TFCBT was effective
in reducing
posttraumatic stress
in former child
soldiers and waraffected boys.

Runyon et al.,
2010

To compare the relative

efficacy of two types of
group cognitive
behavioral therapy for

LOE 4

N=24
parents and
children

treating the traumatized

CPCCBT16
sessions of
treatment over
3
months

KSADSPL for children,

Alabama Parenting
Questionnaire, Child
Behavior Checklist
Reliability/Validity was
established

child

The children and parents in the

This shows the

CPCCBT group demonstrated

benefits of CPCCBT

greater improvements in total

for the parents and

posttraumatic symptoms and

children rather than

positive parenting skills,

just group or

respectively,

individual therapy for

pediatric physical
abuse victims.

Smith et al.,
2008

Does therapy reduce

N=11

abuse-related

participants

suffering from sexual

10 separate
group therapy
sessions based
off of the
workbook,
Survive and

abuse

Thrive,

psychological issues in
CB-GT in children

LOE 6

Clinical Outcomes and

Routine Evaluation, PTSD

Intervention did not affect

Groups seemed to

psychological distress, anxiety,

provide peer support

checklist, Hospital Anxiety

and depression. However,

and normalization of

and Depression Scale, and

results indicated reduced self-

their experiences and

Rosenberg Self Esteem

harm and substance abuse.

feelings, as well as

Scale Reliability/Validity

provide a safe

was established

environment to
communicate in

Swenson et
al.,

Are trials of Multisystem

Therapy for Child Abuse

LOE 2

N=88 youth

None

None

Improvement in youth

Gives a better look

reported PTSD symptoms

at which kinds of

and Neglect for

was significantly greater in

therapy are helpful

physically abused youth

MSTCAN youth across

in children who

and their families

treatment, parents showed

have undergone

effective?

signs of global psychiatric

physical abuse.

distress and number of

positive symptoms MSTCAN
parents showed improvement
in their neglect and
aggression
Thanos

Evidence on the

N=37

effectiveness/

participants

Project SAFE

acceptability of a

LOE 3

psychoeducation group
intervention for managing
mental health and
behavioral problems
associated with a history

This study aimed to find

N=71

out whether PTSD

participants

Therapy groups

Project SAFE

revealed significant decreases in

intervention showed

problematic behavior and

improvement in both

distress.

subclinical and
symptomatic
children.

Brain scans
Reliability/Validity was

Patients with complex PTSD

Emotionally

related to childhood trauma

regulated therapy was

established

reacted favorably to emotional

a clinically

suffered specific structural

regulated and cognitive group

meaningful and

brain trauma and whether

therapy,

patients who received

patients from child abuse

LOE 6

All child outcome measures

established

of child sexual abuse.

Thomases,
2015

Childrens depression
inventory, Childrens
manifest anxiety scale,
Childrens loneliness
questionnaire, Childrens
fear related to victimization
and t Child project safe
evaluation form
Reliability/Validity was

psychological recovery

it were associated

was linked to the

with normalization of

normalcy of

brain function

abnormalities.
White et al.,
2015

LOE 4

Examining the interplay

N=920

of maltreatment

children

Questionnaires, Interviews,

Results that lead to direct

There are

Puppet interviews, Video

benefits in prevention of

multifaceted

characteristic with

Coding, Measurements

maltreatment and give

reactions that

psychological,

(height, weight etc),

evidence based practice for

interact within a

endocrine,

anyone in the field of child

child who has

metabolomic, (epi)

protection

experienced

genomic, and cognitive

None

maltreatment.

motional processes

2. Synthesis
-

Study commonalities: The majority of information gathered from the articles came to the conclusion that group

therapy is most beneficial in childhood trauma when integrated with individual therapy as well. Group therapy has proved to
augment recovery, provide meaningful relationships, and reduce negative consequences related to abuse. Both group and

individual therapy improve family functioning and decreases the likelihood of repeated abuse. Group therapy is able to create a
safe environment, which responds well with the participants. They are able to communicate freely and discuss their feelings
because of all the peer support provided. The articles on CBT also came to the conclusion the that it is an effective form of
therapy that responds better to trauma.

Study differences: The articles in this study included an array of different samples. The subjects in theses studies had

various different types of trauma, including male abuse survivors, survivors with PTSD, sexual abuse cases, and child soldiers.
There were also various different treatment options studied and different results for similar studies. Therapies included childparent combined CBT, trauma focused CBT, group therapy for both child and parent separately, as well as individual therapy for
child and parent separately. Some articles concluded that group therapy was beneficial,while others concluded that individual
therapy was also beneficial. The conclusion we found in our study of these articles does not pinpoint one being more beneficial
than the other, but that a combination of different therapies provides the best outcomes for abuse survivors.

Inconsistencies or gaps among the studies: There were multiple inconsistencies to note when comparing the

studies used for this research. The participants vary from study to study, so it is likely that there may be different
conclusions as to which therapy modalities works best for different populations. Also the method by which subjects
were selected also is inconsistent. This could result in gaps in the study. If the participants were selected on a
voluntary basis, it is possible that the children would decide not to participate in the study or some parents may not
have wanted their child to participate. Some opinions may not be represented that could sway the results of the
study. There is also room for variation within the specific types of therapy used, especially when using broad terms
such as group or individual therapy. There are many different methods that can be used within each type of
therapy which can create additional inconsistencies.
-

Limitations of the studies including threats to validity: While most of these studies resulted in supportive results

for group therapy and childhood physical abuse, there were definitely limitations within each of the studies. One limitation that
was part of most was the lack of participants in each study; many thought that if they had larger sample sizes, they wouldve had
better results in the end. One other limitation I noticed in some studies was the lack of gender equality. Some studies only had
male participants, while others only had female. The researchers in these studies stated that they wished they had a broader
sample to make sure that they were getting all of the data possible. Aside from these two major limitations between the studies,
there were a number of other limitations that were also noted. These included: no direct comparison of treatment effects in
different trauma samples was possible, treatment outcome research on PTSD following childhood abuse appears to lag behind the
gold standard established in PTSD treatment research in general, and a lack of funding, which sometimes affected the amount of
research they could complete in their limited amount of time.

3. Linking Evidence to Practice

Our research concluded that a childs recovery from physical abuse is best augmented with an
individualized therapy regimen including both group and individual therapy separately for the child and
parents along with combined parent-child CBT rather than just one type of therapy.

As a nurse provide initial education, support, and treatment upon incident and then give them a
referral to social services or counseling to specify a therapy plan that best suits their specific needs
Provide judgement free care to the parents of abuse while maintaining a therapeutic relationship with
the child where they feel safe
Foster peer relationships in the group therapy setting because they provide support and normalization
for children recovering from abuse
Encourage combined parent-child cognitive behavior therapy (CPC-CBT) as this is a highly
recommended modality for continued recovery, communication, and reducing recurring incidences of
abuse.

Promote the use of child group and individual therapy to augment recovery and decrease the chances
of long term effects including posttraumatic stress disorder, anxiety, or depression.
Provide emotional support for both the parents and the children throughout both group and individual
therapy
Provide age-appropriate education to both children and parents on about the kinds of therapy they are
receiving and why they are receiving it
Ensure that the environment is a safe place for expression for both the parents and the children

4. References:
Easton, S. D., Leone-Sheehan, D. M., Sophis, E. J., & Willis, D. G. (2015). From that Moment on My Life
Changed: Turning points in the healing process for men recovering from child sexual abuse. Journal of
Child Sexual Abuse, 24(2), 152-173.
Ehring, T., Welboren, R., Morina, N., Wicherts, J., Freitag, J., & Emmelkamp, P. (2014). Metaanalysis of
psychological treatments for posttraumatic stress disorder in adult survivors of childhood abuse. Clinical
Psychology Review, 34(8). doi:10.1016/j.cpr.2014.10.004
Hubel, G. S., Campbell, C., West, T., Friedenberg, S., Schreier, A., Flood, M. F., & Hansen, D. J. (2014).
Child advocacy center based group treatment for child sexual abuse. Journal Of Child Sexual Abuse, 23(3),
304-325.
Karatzias, T., Ferguson, S., Chouliara, Z., Gullone, A., Cosgrove, K., & Douglas, A. (2014). Effectiveness
and Acceptability of Group Psychoeducation for the Management of Mental Health Problems in Survivors
of Child Sexual Abuse (CSA). International Journal of Group Psychotherapy, 64(4), 492-514.
Kjellgren, C., Svedin, C. G., & Nilsson, D. (2013). Child physical abuse experiences of combined treatment
for children and their parents: A pilot study. Child Care in Practice, 19(3), 275-290.
Kolko, D. J. (1996). Individual cognitive behavioral treatment and family therapy for physically abused
children and their offending parents: A comparison of clinical outcomes. Child Maltreatment, 1(4), 322342.
McMullen, J., OCallaghan, P., Shannon, C., Black, A., & Eakin, J. (2013). Group trauma focused cognitive
behavioral therapy with former child soldiers and other war affected boys in the DR Congo: A randomized
controlled trial. The Journal of Child Psychology and Psychiatry, 54(11). doi: 10.1111/jcpp.12094
Runyon, M. K., Deblinger, E., & Steer, R. A. (2010). Group cognitive behavioral treatment for parents and
children at risk for physical abuse: An initial study. Child and Family Behavior Therapy, 32(3), 196-218.
Smith, A. P., & Kelly, A. B. (2008). An exploratory study of group therapy for sexually abused adolescents
and nonoffending guardians. Journal of Child Sexual Abuse, 17(2), 101-116.

Swenson, C. C., Schaeffer, C. M., Henggeler, S. W., Faldowski, R., & Mayhew, A. M. (2010).
Multisystemic therapy for child abuse and neglect: A randomized effectiveness trial. Journal of Family
Psychology, 24 (4), 497-507. doi: 10.1037/a0020324
Thomaes, K., Dorrepaal, E., van Balkom, A. J., Veltman, D. J., Smit, J. H., Hoogendoorn, A. W., & Draijer,
N. (2014). Complex PTSD following early-childhood trauma: emotion-regulation training as addition to the
PTSD guideline. Tijdschrift Voor Psychiatrie, 57(3), 171-182.
White, L. O., Klein, A. M., Kirschbaum, C., Kurz-Adam, M., Uhr, M., Mller-Myhsok, B., ... &
Horlich, J. (2015). Analyzing pathways from childhood maltreatment to internalizing
symptoms and disorders in children and adolescents (AMIS): A study protocol. BMC Psychiatry, 15(1),
126. doi.org/10.1186/s128880150512z