Therapeutic Interventions

1. Outline the family history and disclose all incidents and circumstances involving child mistreatment, neglect and/or sexual or physical abuse. (1, 2, 3, 4)

1. Explore the parent's perceptions and concerns about improper treatment of the child and offer assurance that disclosure is the first step in getting help to terminate the abuse.

2. Elicit a pledge from the parents to terminate all abuse immediately; establish a process to monitor the child's welfare.

3. Gather enough information to categorize the type of abuse and contact an investigative child protection agency if one is not already actively involved with the family.

2. Communicate with the child protection agency and report all known facts and suspicions of abuse. (5, 6, 7)

3. Cooperate with the child protection authorities to ensure the termination of the abuse and the safety and emotional well-being of the child. (8, 9)

4. Explore the family history with the parents to determine if chronic abuse or maltreatment is present or if the mistreatment of the child is an isolated incident.

5. Assist the parents in contacting the proper child protection authorities and completing the required forms if they suspect abuse from another caregiver or support them to disclose their own involvement.

6. Instruct the parents to report any suspected abuse by another caregiver to the state authorized child protection services (CPS) agency or local police department and to keep notes on behaviors, physical marks, or other suspicious evidence in regard to the child.

7. Review with the parents the therapist's obligation regarding the reporting of child abuse and notify them that any information about mistreatment of the child will be communicated to the appropriate CPS agency as required by law.

8. Encourage the parents to cooperate with the CPS caseworkers during the investigative process; request that they permit an exchange of information between the CPS caseworker and their private therapist.

9. Help the parents and the child deal with the legal aspects associated with disclosure of the abuse by providing information about the process and acquiring legal assistance.

4. Cooperate with the legal process and community agencies to acquire long or short-term living arrangements for the child that are safe and promote the development of love, trust, and healthy self-esteem. (10, 11, 12)

5. Share feelings about the abuse and dysfunctional family relationships. (13, 14)

6. Verbalize an awareness of the problems created for the child by overly punitive, abusive, inappropriate, and inconsistent parenting. (15, 16, 17)

10. Instruct the parents to provide background and personal information to the CPS caseworkers to facilitate placement of their child in foster care, if deemed necessary to protect the child.

11. Assist the parents and the child in adjusting to the new living arrangements by addressing the adjustment issues and identifying the positive aspects of the child living in a healthy, abuse-free environment while the family prepares to reunite with the child.

12. Assign the parents to initiate immediate contact with the child's foster parents to plan for a smooth transition.

13. Advise the parents that disclosure of abusive behavior is extremely difficult and painful for both them and the child; encourage the expression and processing of associated feelings.

14. Assign the parents to complete the "Our Family's Secret Story" activity from the Parenting Skills Homework Planner (Knapp) to portray their family's history of abuse.

15. Assign parents to listen to the audiotape Helicopters, Drill Sergeants and Consultants (Fay) to identify their own style of parenting and recognize the advantages of encouraging the child to problem-solve independently.

7. Promote positive character development through family discussions, analyzing literature and media examples, loving interactions, spiritual training, and community involvement. (18, 19, 20)

Establish appropriate parent/ child boundaries and differentiate between adult problems and those that belong to the child. (21, 22, 23)

16. Brainstorm with the parents a list of problems created in the family by overly punitive parenting and discuss how these problems are manifested in their family.

17. Instruct the parents to identify and address areas where the child is using triangulation to divide and control the environment (e.g., creating conflict between family members).

18. Assign the parents to read stories from Where the Heart Is (Moorman) or Chicken Soup for the Soul (Canfield, Hansen, and Kirberger) to stress family togetherness and the important role played by each family member.

19. Encourage family viewing of television or video programs that are consistent with their family values and to hold discussions that allow each family member to react without criticism.

20. Discuss with the parents the significance of regular family attendance at the spiritual organization of their choice for character development, moral training, and family cohesion.

21. Assist the parents in differentiating parental and adult problems from problems that belong to and should be solved by the child.

22. Guide the parents in using proactive discipline strategies (e.g., I-statements, reasonable and

Arrange for the child to begin individual counseling focusing on the emotional reactions to the abuse and reconstructing feelings of trust, love, support, and empowerment. (24, 25, 26)

Attend parent education classes and read parenting literature that teaches techniques of positive discipline. (27, 28)

logical consequences) to modify behavior that is creating a problem for them and supportive interventions (e.g., active listening, encouragement) to assist when the problem belongs to the child.

23. Encourage the parents to allow the child to seek solutions with guidance even if it requires some struggle and learning from mistakes; recommend that they listen to the child's problems with empathy and give assistance only when requested.

24. Assign the parents to schedule regular counseling appointments for the child to ensure psychological support throughout the abuse reporting, investigation, and intervention process.

25. Assign the parents to make a daily emotional assessment of how they and the child are coping with the ramifications of the abuse (or complete the "Measuring Our Feelings" activity in the Parenting Skills Homework Planner by Knapp).

26. Assign the parents and child to meet weekly to review progress, note continuing concerns, and keep a written progress report to share with the child's private therapist.

27. Refer the parents to a parenting class (e.g., Systematic Training for Effective Parenting by Dinkmeyer and McKay) to help them replace abusive parent-child interactions with techniques of positive discipline.

Grant specific freedoms consistent with the child's maturity and level of self-control. (29, 30)

Report a reduction in power struggles resulting from strategies designed to enlist the child's cooperation. (31, 32)

Single parents seek respite, support, and encouragement from co-parent, family, and friends. (33, 34, 35)

28. Assign the parents to read literature about implementing strategies of positive discipline in their family (e.g., Kids Are Worth It! by Coloroso, Children: The Challenge by Dreikurs).

29. Recommend that the parents grant privileges and choices consistent with the child's level of maturity and responsible behavior.

30. Teach the parents to use the phrase "Soon you'll be on your own" to encourage the child to earn freedom from parental monitoring by demonstrating independent and responsible behavior (see Parent Talk by Moorman).

31. Teach the parents methods of sidestepping power struggles (e.g., using a broken record response, choices, refusing to argue); ask them to record the results in a discipline journal.

32. Assist the parents and the child in establishing a verbal or nonverbal cue to signal the need to break the cycle of negative behavior or abusive reaction by implementing a prearranged strategy (e.g., time out, change the location of the behavior, or switch activities).

33. Brainstorm with the single parent a list of support people who can be called on to babysit, console, and help out in case of emergency.

34. Identify with the single parent several community agencies available to offer assistance and

14. Solicit assistance from social service agencies that provide support, guidance, and respite. (36, 37)

15. Increase the family's and the child's social interaction with the school, classmates, and friends. (38, 39)

16. Invite extended family members to parenting classes and/or counseling sessions. (40)

support (e.g., respite care, single parent support groups).

35. Discuss with the single parent or separated parents the importance of cooperation in the co-parenting process and offer to mediate any current roadblocks or refer them to an independent mediator.

36. Refer the parents to community agencies and services designed to support families struggling with parent/child or abuse issues (e.g., Visiting Nurses, family abuse counseling services) or refer them to a national support resource (e.g., Childhelp, U.S.A.: (800) 422-4453).

37. Assist the parents in listing their personal and family resources for respite from the demands of managing the family (e.g., friends, family, church members); urge them to utilize the resources on a regular basis.

38. Assign the parents to encourage the child to join a social group or club by brainstorming options and helping the child make a selection.

39. Encourage the family to become involved with social activities at school (e.g., PTA, sports events, concerts).

40. Suggest that the parents invite the grandparents to parenting classes or a counseling session to help them understand their newly acquired discipline strategies.

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