Children experiencing physical abuse by their parents are left with several difficult decisions. The present study aims at exploring the process of disclosing the abuse and the responses from social welfare workers from a child perspective, in a Swedish context. Data was obtained from in depth interviews with 15 children with a history of child physical abuse. A qualitative content analysis was conducted in order to capture the children's experiences. Disclosing abuse was described as a process including several judgements from the child. Children describe their everyday life before disclosing, with an escalation of violence making them think they have to act in order to prevent further abuse. They made several well-thought decisions and selected a trustworthy recipient. The decision to disclose was often made out of fear, but the fear could remain after the disclosure, not knowing what will happen next. Children seem to lose control over how their abuse narratives are handled after disclosing. The recipient and social welfare worker was acting but not informing or consulting the child. Children emphasize the importance of trustworthy and competent adults when disclosing physical abuse. Ethical issues and implications for practice are discussed.

Practitioner messages

• Disclosure is to be seen as a process, including several judgements by the child.

• Children emphasize the importance of trustworthy and competent adults when choosing to disclose physical abuse.

• Social welfare workers should inform and include children in their decision making.

Although many children across cultures are victims of physical abuse, few treatment models target these children and their parents. In Sweden, Combined Parent-Child Cognitive Behavioural Therapy for families at risk for child physical abuse has been successfully used according topretreatment and posttreatment studies. However, few studies have explored how physically abused children experience treatment. This study includes 20 physically abused children aged 9-17 who completed Combined Parent-Child Cognitive Behavioural Therapy. Children had a positive overall impression of the treatment and highlighted addressing the abuse, as well as processing their experiences as particularly essential. Children described a positive transformation in their family life as a result of treatment, including violence cessation and bonding among family members. Children experienced the intervention as inclusive and child-friendly. The implications of the promising findings are discussed.

This study explores the outcome of the intervention combined parent child–cognitive behavioral therapy (CPC-CBT) for physically abused children. This study includes a clinical sample of children (n = 62) referred to Child Welfare Service due to reports of child physical abuse who completed CPC-CBT. A pretest/posttest design was applied to assess changes on the Trauma Symptom Checklist for Children (TSCC) after treatment and was compared with normative values. In addition, the occurrence of corporal punishment from pre to posttest was explored.

Children reported a significant decrease in parental use of corporal punishment after treatment and a significant reduction in symptoms associated with trauma (decreased to normal values for TSCC). The positive changes remained at the 6-month follow-up.

The CPC-CBT intervention seemed to decrease parental use of corporal punishment and increase the well-being of children. Clinical implications are discussed.

Aim: The overall aim of the thesis is to explore the experiences and possible consequences concerning reported health and relations between a parent perpetrator of physical child abuse and the children who are victims of the parental physical abuse, the children’s thoughts when disclosing the abuse, and the impact of an intervention designed to support these children in a Swedish context – Combined Parent Child Cognitive Behavioral Therapy (CPC-CBT). Methods: This thesis has a mix-method design. Study I and IV used different self-assessment scales, and the outcomes were analysed using descriptive statistics, paired-samples t test, independent t test, ANOVA, Pearson correlations, and hierarchical linear regression. Study II and III consisted of interviews with 15 (Study II) and 20 (Study III) children, respectively. The interviews were transcribed verbatim and analysed using qualitative content analysis. Results: The results suggest that experiencing child physical abuse affects the relationship between a parent and a child as well as the child’s wellbeing in several ways. However, the results also suggest that participating in the CPC-CBT intervention could decrease parents’ use of violence and increase the child’s wellbeing. In addition, the results suggest that trust and participation influence whether a child discloses abuse and contributes to the success of treatment. Conclusion: The CPC-CBT could be seen as a successful turning point for the participating children, shifting from one trajectory (living in fear of violence) to another (living without fear). Furthermore, when children disclose to adults about their physical abuse, it is important that the adults recognise the children’s participatory rights and strive to earn their trust.

This article explores adolescent’s reports of parental strategies and sense of coherence (SOC). Building on the suggested impact of child physical abuse, this study compares reports from a group of physically abused youth and a group of non-abused youth. Independent t-test, correlations and hierarchical linear regression analysis were computed. Findings indicate that parents’ use of corporal punishment could affect how youth report their parent’s parental strategies. Physically abused youth report less parental involvement and positive parenting as well as more inconsistent parenting than non-abused youth. Furthermore, physically abused youth report a significant lower SOC than non-abused youth. Being a victim of physical abuse had a unique contribution on SOC, even after controlling for other parental strategies. Taken together, the results suggest that child physical abuse affects both the youth’s inner SOC as well as their reports of parental strategies in several ways. Implications for practice are discussed in this article.

För tio år sedan introducerades en evidensbaserad behandlingsmodell vid barnmisshandel i Sverige och en omfattande implementeringsprocess inleddes. Behandlingsmodellen KIBB (CPC-CBT, Combined Parent Child-Cognitive Behavioral Therapy) introducerades som ett bottom-up initiativ från socialt arbete. Implementeringen kan beskrivas utifrån faserna behovsinventering, installation av metoden, metoden börjar användas och vidmakthållande av metoden. Fyra team utbildades inledningsvis och lovande resultat av behandlingen identifierades i en pilotstudie. Fortsatt implementering pågår och ytterligare ett hundratal behandlare har utbildats i metoden. Mer än tusen familjer har hittills fått del av behandlingen. I pågående studier undersöks behandlingseffekter och barns upplevelser av behandlingsinterventionen. Erfarenheter från implementeringsprocessen liksom remitterande socialsekreterares uppfattningar om behandlingsprogrammet presenteras i artikeln. Erfarenheterna från tio års implementering diskuteras, där såväl hinder som framgångsfaktorer i implementeringsprocessen identifierats.

This chapter addresses the psychological treatment for children who have experienced parental physical abuse, as reported to child welfare services. For children, physical abuse can increase the risk of both internal and external behavioural problems. Since abused children often continue to live with their parents‚ it is important to offer interventions to prevent further abuse and to improve the child´s well-being. In this chapter‚ we describe a specialised intervention, Combined Parent – Child Cognitive Behavioural Therapy (CPC-CBT), for families at risk for child physical abuse, which has been implemented in several Swedish Barnahus over the last 9 years. We report the results from an ongoing research study into the effects of the intervention on the risk of victimisation, parenting strategies and child well-being. The results suggest that Barnahus is a suitable context for providing support for families and that CPC-CBT is an effective intervention.