Academic journal article Journal of Evidence-Based Psychotherapies

A Naturalistic Study of Effectiveness and Cost-Benefit Analysis of a Cognitive Behavioral Program for Reducing the Risk of Child Separation from Family

Academic journal article Journal of Evidence-Based Psychotherapies

A Naturalistic Study of Effectiveness and Cost-Benefit Analysis of a Cognitive Behavioral Program for Reducing the Risk of Child Separation from Family

Article excerpt


A naturalistic study regarding the effectiveness of a cognitive behavioral program for reducing the risk of child separation from family is described. One hundred twenty six families that undertook either a systemic or a cognitive behavioral family intervention in a Child and Parent Counseling Center were included in this study. Families were evaluated regarding the risk for child separation before and after intervention. Results showed that cognitive behavioral and systemic-based interventions are effective in reducing both the imminence and the risk for separation of the children from family and show financial benefits for child protection services.

Keywords: cognitive behavioral intervention, cost-benefit analysis, effectiveness, child separation from family


A major challenge for social assistance and child protection services is the risk of child separation from family. Among the main causes of child separation from family in Romania are abuse, neglect, abandonment and death of the parents, temporary parental incapacity (UNICEF, 2005).

Different services such as cognitive behavioral therapy, home visitation and group therapy in child protection have proved to be effective in reducing child abuse and neglect (O'Reilly, Wilkes, Luck, & Jackson, 2010) but contradictory findings exists regarding the efficacy of intensive family preservation services for out-of-home child placement (Berry, Cash, & Brook, 2000).

In order to reduce child separation and child separation risk, Romanian state level policy is to make the local community open preventive services such as counseling centers, day care centers and so on, but no indications exists about the efficiency of specific services in reducing risk of child separation. Moreover, we are not aware of any data indicative of the efficacy of these services in reducing child separation in Romania.

Cognitive behavioral interventions are validated strategies for a large range of emotional and behavioral problems in different setting (Dobson & Dozois, 2001). Cognitive behavioral therapy (CBT) was shown to reduce abuse and neglect (Bugental et al., 2002) and to improve both parent and family outcomes (O'Reilly, et al., 2010). Moreover, substantial evidence supports the efficacy of systemic approaches for high risk youths with antisocial behavior (Henggeler, Melton, Smith, Schoenwald, & Hanley, 1993).

In this study we describe the effectiveness of a case formulation-based, team-delivered cognitive behavioral family programme in reducing child separation risk in the case of families at risk of child separation. Also we compare the effectiveness of the CBT-driven intervention with a systemic therapy-driven intervention for families with high risk of child separation. In team-delivered case formulation-driven approach to family CBT, a clinician specialized in CBT develops an individualized case formulation and uses it to select and adapt interventions that will be used by the different professionals to fit the case at hand.

Our hypothesis was that a team-delivered, case formulation-driven CBT program would reduce both child separation risk and imminence. Scores of child separation risk of the families included in the study were compared before receiving the services and after termination.

We also examined the differences between two programs, the CBT-driven one and a systemic therapy-driven one, in their impact on risk and imminence for child separation.

Finally we addressed the financial costs and benefits of the CBT program by comparing the costs for running the program with the costs of keeping children out of the residential child protection system.



One hundred twenty six families, beneficiaries of the services of the Counseling Center for Parents and Families in 2010, were evaluated to be included in the study. Out of the families evaluated, 76 received a CBT-driven approach, and 50 families received a systemic- driven approach. …

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