Preventing Maltreatment with a Community-Based Implementation of Parent–Child Interaction Therapy

The purpose of this study was to examine rates of child abuse and neglect reports following a community implementation of Parent–Child Interaction Therapy (PCIT), an evidence-supported intervention for the prevention of maltreatment. Among a group of families receiving PCIT, predictors of reports were examined including family demographics, course of treatment, changes in clinical measures, and caregiver report for prior maltreatment victimization and perpetration. Participants (n = 120) included families at-risk for future maltreatment with and without prior maltreatment history. Agency case records were linked with state administrative records of child welfare reports. Time to follow-up ranged from 13 to 40 months. Bivariate and multivariate survival analyses were used to model risk for a later report. During the follow-up period, 12.5 % of families had a report for physical abuse or neglect. Reports of prior victimization as a child and prior perpetration as an adult were strong predictors of a report of perpetration after PCIT. Dosage of PCIT and change in clinical measures did not increase risk for a later report. PCIT can be an effective intervention for preventing maltreatment. Family history of child welfare involvement is a prominent factor in assessing risk for future involvement.     

The Effectiveness of Group Parent–Child Interaction Therapy with Community Families

Parent–Child Interaction Therapy (PCIT) is a behavioral, parent-training program that incorporates both operant learning and play therapy techniques to treat child disruptive behavior problems. The present pilot study examined the use of a group PCIT protocol with a mixed clinical sample of primarily low-socioeconomic status community families. Forty families with a child between the ages of 2 and 8 years old were either self-referred to the group or referred by child protective services, and 27 began treatment. Following a standard group PCIT protocol, 17 families completed treatment. Caregivers who completed the PCIT group reported a significant decrease in child disruptive behavior and parenting stress following completion of the 12-week group. Behavior observations of the treatment completers revealed a significant increase in parent prosocial behavior and a decrease in inappropriate parent behavior from pre- to post-treatment. As there have been no demonstrations, to date, of group PCIT in a community-based setting, this study presents evidence that PCIT is a promising treatment format for dissemination research and practice. The benefits and challenges of using a group PCIT format for delivery of clinical services are discussed.     

Utilizing Benchmarking to Study the Effectiveness of Parent–Child Interaction Therapy Implemented in a Community Setting

Benchmarking is a program evaluation approach that can be used to study whether the outcomes of parents/children who participate in an evidence-based program in the community approximate the outcomes found in randomized trials. This paper presents a case illustration using benchmarking methodology to examine a community implementation of Parent–Child Interaction Therapy (CI-PCIT) utilized as a child maltreatment prevention effort. Data were collected from 83 parent–child dyads. Change scores were compared to treatment and control effect sizes aggregated from the PCIT literature. Pre-post results indicated significant positive changes in child behavior for CI-PCIT completers. Benchmarking analyses revealed that parents who completed CI-PCIT reported significantly greater positive child outcomes than the aggregate control group benchmark, and significantly less than observed in the treatment benchmark. A summary of decision points and implications for utilizing this methodology in the child maltreatment field are postulated.     

Predicting Treatment and Follow-up Attrition in Parent–Child Interaction Therapy

Predictors of attrition from individual parent–child interaction therapy were examined for 99 families of preschoolers with disruptive behavior disorders. Seventy-one percent of treatment dropouts were identified by lower SES, more maternal negative talk, and less maternal total praise at pretreatment. Following PCIT, families were randomly assigned to an Assessment-Only or Maintenance Treatment condition. Higher maternal distress predicted 63% of dropouts in the Assessment-Only condition. Lower maternal intellectual functioning predicted 83% of dropouts from Maintenance Treatment. Findings highlight a continuing need for evidence-based retention strategies at various phases of engagement in PCIT. This study was funded by the National Institute of Mental Health (RO1 MH60632). We thank the members of the UF Child Study Laboratory for their contributions to this study.     

Comparison of Mothers' and Fathers' Opinions of Parent–Child Interaction Therapy

Opinions of parenting programs mostly have been obtained from mothers. Because mothers and fathers' interactions with children differ, gathering data from both parents regarding behavior modification and parenting programs is necessary. This project was part of a larger study and compared mothers and fathers' acceptability of Parent-Child Interaction Therapy (PCIT) and its various components. Acceptability data were obtained using the Treatment Evaluation Inventory-Short Form and a modified version of this measure assessing specific PCIT components. The sample consisted of 40 community mother-father pairs of a young male child. Findings suggest gender differences in PCIT treatment acceptability and various PCIT components.     

A Community Mental Health Implementation of Parent–Child Interaction Therapy (PCIT)

Parent–Child Interaction Therapy (PCIT) has been identified as an evidence-based practice in the treatment of externalizing behavior among preschool-aged youth. Although considerable research has established its efficacy, little is known about the effectiveness of PCIT when delivered in a community mental health setting with underserved youth. The current pilot study investigated an implementation of PCIT with primarily low-socioeconomic status, urban, ethnic minority youth and families. The families of 14 clinically referred children aged 2–7 years and demonstrating externalizing behavior completed PCIT initial assessment, and 12 began treatment. Using standard PCIT completion criteria, 4 families completed treatment; and these families demonstrated clinically significant change on observational and self-report measures of parent behavior, parenting stress, and child functioning. Although treatment dropouts demonstrated more attenuated changes, observational data and parent-reported problems across sessions indicated some improvements with lower doses of intervention. Attendance and adherence data, referral source, barriers to treatment participation, and treatment satisfaction across completers and dropouts are discussed to highlight differences between the current sample and prior PCIT research. The findings suggest that PCIT can be delivered successfully in an underserved community sample when families remain in treatment, but that premature dropout limits treatment effectiveness. The findings suggest potential directions for research to improve uptake of PCIT in a community service setting.     

The Relation between Parent Mental Health and Child Internalizing Symptoms in Parent–Child Interaction Therapy

Journal of Child and Family Studies - The present study evaluated whether families receiving Parent–Child Interaction Therapy (PCIT) experienced significant improvements in both parent and...     

Parent–Child Interaction Therapy and Chronic Illness: A Case Study

We examined the outcome of parent–child interaction therapy (PCIT) for a child diagnosed with Oppositional Defiant Disorder (ODD) and cancer. Robert, a 4-year-old Caucasian male, showed significant and meaningful changes in his behavior over the course of 13 weeks of PCIT, and Robert no longer met diagnostic criteria for ODD following treatment. His scores on the Eyberg Child Behavior Inventory and the Achenbach Child Behavior Checklist were in the clinical range before treatment and in the normal range at the conclusion of treatment. His mother also reported dramatic improvements in Robert's behavior during medical visits. Physician and social worker reports were consistent with her report. Such anecdotal data may have implications for the generalization of compliance to the medical setting for children with chronic illnesses. The results of this case study should prompt further investigation of parent-training interventions for children with chronic illnesses and disruptive behavior.     

Assessing the Key to Effective Coaching in Parent–Child Interaction Therapy: The Therapist-Parent Interaction Coding System

This paper describes the initial evaluation of the Therapist-Parent Interaction Coding System (TPICS), a measure of in vivo therapist coaching for the evidence-based behavioral parent training intervention, parent–child interaction therapy (PCIT). Sixty-one video-recorded treatment sessions were coded with the TPICS to investigate (1) the variety of coaching techniques PCIT therapists use in the early stage of treatment, (2) whether parent skill-level guides a therapist’s coaching style and frequency, and (3) whether coaching mediates changes in parents’ skill levels from one session to the next. Results found that the TPICS captured a range of coaching techniques, and that parent skill-level prior to coaching did relate to therapists’ use of in vivo feedback. Therapists’ responsive coaching (e.g., praise to parents) was a partial mediator of change in parenting behavior from one session to the next for specific child-centered parenting skills; whereas directive coaching (e.g., modeling) did not relate to change. The TPICS demonstrates promise as a measure of coaching during PCIT with good reliability scores and initial evidence of construct validity.     

Examining the Efficacy of Parent–Child Interaction Therapy with Children on the Autism Spectrum

Externalizing behaviors are a common component of the clinical presentation of autism spectrum disorders. Although traditionally used with typically-developing children, parent–child interaction therapy (PCIT) is one behaviorally-based parent training program that has demonstrated success in increasing child compliance, reducing problem behavior, and improving parent–child communication. The study examined the efficacy of PCIT as a treatment for children with autism spectrum disorders by employing a single subject, non-concurrent multiple baseline design across three subjects. Primary findings revealed increases in child compliance, reductions in child disruptive behavior, and improved parenting skills across participants. In addition, each caregiver reported high levels of satisfaction with the intervention. Results suggested that PCIT may be a treatment option for children on the autism spectrum with co-occurring behavioral difficulties. Although the non-concurrent nature of the multiple baseline design is a limitation, this study replicates and extends previous research investigating the efficacy of PCIT with children with autism and their parents.     

Parent–Child Interaction Therapy: One- and Two-Year Follow-Up of Standard and Abbreviated Treatments for Oppositional Preschoolers

The long-term effect of two parent training programs for conduct problem preschoolers is reported. Families of 54 behaviorally disturbed preschool-aged children were randomly assigned to 1 of 3 treatment conditions: standard Parent-Child Interaction Therapy (STD), an abbreviated form of PCIT (ABB), and a no-treatment waitlist control group (WL). Of the families who completed treatment (STD and ABB), data were collected on 97% and 94% of families at 1- and 2-year follow-up, respectively. Follow-up assessment of parent report and independent observations indicated that treatment gains were largely maintained for both treatment conditions with little difference between the two treatments. The findings suggest that an abbreviated form of PCIT has long-term benefits for families with young children displaying early conduct problems.     

Differential Attention as a Mechanism of Change in Parent–Child Interaction Therapy: Support from Time-Series Analysis

Although many interventions address children’s externalizing behavior problems, negative treatment outcomes remain common. Reasons for success or failure are frequently unclear, due in part to a lack of research identifying treatment change mechanisms. The current study evaluated differential attention as a mechanism of change in Parent–Child Interaction Therapy (PCIT), a treatment for children with externalizing problems. Using sequential coding and time-series analysis, we examined parent–child interactions across treatment for three families. Contrary to hypotheses, child prosocial behaviors and parent skill use held steady or decreased across coaching periods, with the exception of one family, where the parent’s skill use increased during coaching. Partial support was found for the hypothesis that parent differential attention would predict child prosocial behavior in the next minute. These results provide support for differential attention as a mechanism of change, but also demonstrate that this factor is not the only such mechanism.     

Assessing the Quality of the Parent–Child Relationship: Validity and Reliability of the Child–Parent Relationship Test (ChiP-C)

The ChiP-C is a clinically oriented questionnaire for assessing the quality of the child-parent relationship according to the child’s subjective appraisal. The ChiP-C is based on family systems theory and a cumulative vulnerability model. The questionnaire consists of 36 items representing three resource scales, five risk scales, and one additional scale. This article presents the theoretical framework and main psychometric properties of the ChiP-C. A school-based sample of 1,377 youth (ages 10–20; M = 14.4) and a clinic-referred consecutive sample of 197 patients (ages 10–18, M = 14.0) were surveyed. Construct validity was determined by confirmatory factor analyses. The mean of the internal consistencies was 0.79. Systematic correlations between the ChiP-C scales and the German EMBU confirmed the convergent and discriminant validity of the ChiP-C. Moreover, all ChiP-C scales were shown to be significantly correlated with psychopathological symptoms as measured by parent and youth questionnaires. The ChiP-C can be considered an economical screening instrument for a reliable and valid assessment of strengths and disturbances of the child-parent relationship according to the child’s subjective appraisal.     

Intergenerational Continuity in Qualities of the Parent–Child Relationship: Mediating and Moderating Mechanisms

Intergenerational continuity in parenting quality has been demonstrated but the mechanisms underlying this continuity are less understood. This study investigated whether the offspring personality and years of education mediate the continuity in qualities of the parent–child relationship and whether offspring personality moderates this association. The sample comprised 1308 Finnish offspring (G2; 62% female) and their mothers (G1). G1 (Mean age?=?37.7) reported self-perceived qualities of the parent–child relationship in terms of emotional warmth and acceptance towards G2 aged 3–18 years in 1980. Thirty-two years later, once having become parents themselves, G2 (Mean age?=?42.9) self-rated their own qualities of the parent–child relationship towards their children using the same scales. Between these follow-ups, G2 self-rated their personality (consisting of temperament and character traits) using the Temperament and Character Inventory and reported years of education. Results indicated that G2 character traits—Self-directedness and Cooperativeness—partially mediated the intergenerational continuity in self-perceived emotional warmth and explained 16% of this association. No mediating role of G2 temperament traits was found (all ps?>?.240). Character traits accounted for the indirect association better than education in a multiple mediator model. Moreover, no moderating role of either temperament or character traits was found (all ps?≥?.064). Study findings show that warm and accepting qualities of the parent–child relationship in childhood are related to offspring character traits that reflect personality maturity in adulthood, which in turn would predict their own positive parent–child relationship later in life.     

Interaction Between the Parenting Alliance and Parent–Child Activities in a Clinic-Referred Sample of 2 to 18-year-olds

Several decades of research have demonstrated a link between marital, parenting, and child domains. The present study examined the nature of these links by testing the moderating effect of the parent–child relationship on the association between the parenting alliance and internalizing and externalizing problems in 324 dual-parent families of 2-to-18-year-old clinic-referred youth. Findings indicated that positive parent–child activities directly related to children’s internalizing and externalizing problems, and modified the nature of the association between the parenting alliance and internalizing problems in families of 6-to-10-year-olds. Interestingly, in families where parents engaged in fewer positive activities with their children, a strong parenting alliance actually related to greater child internalizing problems. Findings support the importance of understanding the interaction between the marital and child domains in order to effectively intervene with families of children experiencing behavior problems.     

Methodological Issues in the Direct Observation of Parent–Child Interaction: Do Observational Findings Reflect the Natural Behavior of Participants?

This review examines evidence for the utility and validity of direct observational techniques for answering particular research and clinical questions. Observational techniques often involve recording behavior in settings that are relatively unnatural for families. However, it is argued that construct validity of observational methods depends partly on whether the findings are representative of participants' typical everyday behavior. Evidence is reviewed concerning whether observational findings are affected by the presence of the observer, and by two factors which have been neglected in the literature, namely the type of task imposed by the observer (e.g., directing parent and child to play rather than observing spontaneous interaction) and the location of the observations (e.g., clinic or laboratory rather than home). The review suggests that the presence of an observer does not necessarily distort the nature of interactions. However, the small number of studies in this area suggest that interactions in structured or artificial settings are not necessarily representative of those normally taking place at home.