Physical child abuse: A comprehensive family based approach to treatment

Physical abuse within the family may be conceptualized as the outcome of a complex process in which a child with particular characteristics which rendered him or her vulnerable to abuse, is injured by a parent involved in an ongoing problematic behaviour pattern, subserved by particular belief systems and constrained by historical, contextual and constitutional predisposing factors. When families are referred by statutory child protection agencies to therapy services for treatment, initially a contract for comprehensive assessment should be established with the family and referrer. Assessment should involve interviews with all members of the child system and should cover relevant risk and protective factors and a verbal reconstruction of the abusive incident. A contract for treatment may be offered if the assessment shows that the parents accept responsibility for the abuse, are committed to meeting their child's needs, are committed to improving their own psychological wellbeing and where they have the ability to change. Treatment should be based on clear contracts to meet specific targets. Treatment and case management plans involve a central focus on improving parent-child interaction through direct work with parents and children together. This may be supplemented with couples work, interventions in the wider system and individual work for parents focusing on parent-craft and the management of personal difficulties such as mood and anger regulation. Children may also receive input in therapeutic pre-school placements.