Beverly W. Funderburk

Parent-child interaction therapy with physically abusive parents: efficacy for reducing future abuse reports

A randomized trial was conducted to test the efficacy and sufficiency of parent-child interaction therapy (PCIT) in preventing re-reports of physical abuse among abusive parents. Physically abusive parents (N=110) were randomly assigned to one of three intervention conditions: (a) PCIT, (b) PCIT plus individualized enhanced services, or (c) a standard community-based parenting group. Participants had multiple past child welfare reports, severe parent-to-child violence, low household income, and significant levels of depression, substance abuse, and antisocial behavior. At a median follow-up of 850 days, 19% of parents assigned to PCIT had a re-report for physical abuse compared with 49% of parents assigned to the standard community group. Additional enhanced services did not improve the efficacy of PCIT. The relative superiority of PCIT was mediated by greater reduction in negative parent-child interactions, consistent with the PCIT change model.

Parent-Child Interaction Therapy with Behavior Problem Children: One and Two Year Maintenance of Treatment Effects in the Family

ABSTRACT Parent-Child Interaction Therapy (PCIT) is an empirically supported treatment for conduct-disordered young children in which parents learn the skills of child-directed interaction (CDI) in the first phase of treatment and parent-directed interaction (PDI) in the second. This study examined the long-term treatment outcome for 13 families who had participated in a treatment study examining the effects of treatment phase sequence one and two years earlier. Seven families were in the CDI-First treatment group and six families were in the PDI-First group. Immediately after treatment, 11 of the 13 families had achieved clinically significant changes on both observational and parent report measures, and there is no significant difference between treatment groups. Treatment effects were maintained at one-year follow-up for eight of the 13 families, and at two-year follow-up for nine families, with no long- term impact of phase sequence evident at either follow-up assessment. This study represents the first long-term follow-up of families treated with PCIT. Results suggest that this treatment may be successful in achieving long-term gains for most families of conduct-disordered preschoolers and that phase sequence has little impact on treatment outcome.

A combined motivation and parent–child interaction therapy package reduces child welfare recidivism in a randomized dismantling field trial.

OBJECTIVE A package of parent-child interaction therapy (PCIT) combined with a self-motivational (SM) orientation previously was found in a laboratory trial to reduce child abuse recidivism compared with services as usual (SAU). Objectives of the present study were to test effectiveness in a field agency rather than in a laboratory setting and to dismantle the SM versus SAU orientation and PCIT versus SAU parenting component effects. METHOD Participants were 192 parents in child welfare with an average of 6 prior referrals and most with all of their children removed. Following a 2 x 2 sequentially randomized experimental design, parents were randomized first to orientation condition (SM vs. SAU) and then subsequently randomized to a parenting condition (PCIT vs. SAU). Cases were followed for child welfare recidivism for a median of 904 days. An imputation-based approach was used to estimate recidivism survival complicated by significant treatment-related differences in timing and frequency of children returned home. RESULTS A significant orientation condition by parenting condition interaction favoring the SM + PCIT combination was found for reducing future child welfare reports, and this effect was stronger when children were returned to the home sooner rather than later. CONCLUSIONS Findings demonstrate that previous laboratory results can be replicated in a field implementation setting and among parents with chronic and severe child welfare histories, supporting a synergistic SM + PCIT benefit. Methodological considerations for analyzing child welfare event history data complicated by differential risk deprivation are also emphasized.

Further Psychometric Evaluation of the Eyberg and Behar Rating Scales for Parents and Teachers of Preschoolers.

The psychometric properties of two parent behavior rating scales, the Eyberg Child Behavior Inventory (ECBI) and the Preschool Behavior Questionnaire – Parent-Completed (PBQ-P), and two teacher rating scales, the Sutter-Eyberg Student Behavior Inventory (SESBI) and the Preschool Behavior QuestionnaireTeacher-Completed (PBQ-T) were examined in a homogeneous community sample of 88 preschool children between 2 and 6 years of age.

A motivational intervention can improve retention in PCIT for low-motivation child welfare clients.

A motivational orientation intervention designed to improve parenting program retention was field tested versus standard orientation across two parenting programs, Parent—Child Interaction Therapy (PCIT) and a standard didactic parent training group. Both interventions were implemented within a frontline child welfare parenting center by center staff. Participants had an average of six prior child welfare referrals, primarily for neglect. A double-randomized design was used to test main and interaction effects. The motivational intervention improved retention only when combined with PCIT (cumulative survival = 85% vs. around 61% for the three other design cells). Benefits were robust across demographic characteristics and participation barriers but were concentrated among participants whose initial level of motivation was low to moderate. There were negative effects for participants with relatively high initial motivation. The findings suggest that using a motivational intervention combined with PCIT can improve retention when used selectively with relatively low to moderately motivated child welfare clients.

Change trajectories for parent-child interaction sequences during parent-child interaction therapy for child physical abuse

OBJECTIVE Parent-child interaction therapy (PCIT) has been found to reduce future child abuse reports among physically abusive parents. Reductions in observed negative parenting behaviors mediated this benefit. The current study examined session-by-session interaction sequences in order to identify when during treatment these changes occur and how much the trajectory varies from case-to-case. METHOD Session-by-session parent-child interaction sequences, using the Dyadic Parent-Child Interaction Coding System-II (DPICS-II) categories, were coded for 22 child welfare involved parent-child dyads undergoing PCIT for child physical abuse. A total 5,436 interactions across PCIT were coded and analyzed using growth curve analysis. RESULTS At pre-treatment baseline, negative and positive parental responses were about equally likely to follow a child positive behavior. This pattern changed rapidly during PCIT, with rapid increases in positive parental responses and decreases in negative parental responses to appropriate child behavior. A quadratic growth pattern accounted for 70% of observed variance and virtually all change occurred during the first three sessions. CONCLUSION Changes in observed abusive parent-abused child interaction patterns can occur early in PCIT, a parenting intervention that involves direct coaching and practice of skills. These benefits sustained throughout treatment. PRACTICE IMPLICATION Prior to receiving behavioral parent training (PCIT), parents who have physically abused their children failed to match their parental response to their childrens behavior. This pattern of interaction improved rapidly and substantially during the first three sessions of PCIT. The changes in the patterns of interaction also remained relatively stable for the remainder of treatment while parents continued to practice positive parental responses as well as began practicing effective discipline techniques. This suggests that use of immediate parent feedback through coaching, explicit directions to parents in how to respond to child behavior, and customization of the application of skills to the problems that arise in session are important components to effective parenting programs with physically abusive parents. Targeting these behaviors with PCIT has been found to reduce rates of recidivism, further supporting clinical application of PCIT in these cases.

Use and feasibility of telemedicine technology in the dissemination of Parent-Child Interaction Therapy.

This brief report discusses the use and feasibility of telemedicine technology in the dissemination of Parent-Child Interaction Therapy (PCIT). PCIT is an empirically supported behavioral parent training program for reducing disruptive behavior in young children and for reducing future rates of child physical abuse. The positive impact PCIT has demonstrated in reducing child maltreatment has galvanized interest in widespread dissemination of the PCIT model into child service systems. PCIT has traditionally been taught in university-based training programs in a mentored cotherapy model. By contrast, in field settings, PCIT training typically consists of workshop training supplemented by a period of telephone consultation (PC). Given concerns with the level of practitioner competency and fidelity yielded by the PC model, PCIT training programs have begun to examine Internet-based telemedicine technology to deliver live, mentored PCIT training to trainees at remote locations (Remote Real-Time or RRT) to better approximate the university-based training model. Challenges of disseminating evidence-based practices are discussed, using PCIT as a model of how these challenges are being addressed by telemedicine technology.

Psychometric Properties and Reference Point Data for the Revised Edition of the School Observation Coding System

The psychometric properties of a new observation coding system for childrens disruptive classroom behavior were evaluated. The Revised Edition of the School Observation Coding System (REDSOCS) was used to observe 51 young children clinic-referred for conduct-disordered behavior and 182 nonreferred children from the classrooms of the referred children. Reference point data for the REDSOCS categories with preschoolers were obtained from the sample of nonreferred children. Interobserver reliability and concurrent validity of the three REDSOCS categories with teacher rating scales of oppositional behavior and hyperactivity were demonstrated. Initial evidence of convergent and discriminant validity was established through correlations of the REDSOCS categories with the subscales of the Revised Conners Teacher Rating Scale. Differences in REDSOCS scores between the nonreferred children and children referred for school behavior problems provided

Therapists' Attitudes Toward Evidence-Based Practices and Implementation of Parent-Child Interaction Therapy

Child abuse and neglect affects many families each year, but evidence-based parent training programs can be instrumental in reducing maltreatment. Parent–Child Interaction Therapy, a parent training program developed for treatment of disruptive child behavior, has demonstrated effectiveness with families at risk of or exposed to child maltreatment. However, methods for disseminating this evidence-based intervention in community settings are not well understood. This study examined the association between community-based therapists’ attitudes toward evidence-based practices (EBPs) and their participation in an implementation research project in which they received two forms of consultation. Results showed that therapists’ self-reported unwillingness to diverge from EBPs was positively associated with their use of phone consultation and satisfaction with consultation. The degree to which therapists found EBPs appealing was positively associated with satisfaction as well. Open therapist attitudes toward EBPs were associated with greater attendance for online consultation. The next step in this line of research is to examine how therapists’ attitudes toward EBPs can be improved, if changing attitudes affects therapist acquisition of treatment skills, and if such improvements enhance implementation efforts.

Comparing Client Outcomes for Two Evidence-Based Treatment Consultation Strategies.

Posttraining expert case consultation is a key component of transporting and scaling up evidence-based treatments, and hopefully retaining their efficacy. Live practice observation and in vivo coaching is a strategy used in academic training environments, but is rarely feasible in field settings. Post hoc telephone consultation is a substitute strategy but does not approximate many aspects of live coaching. Live video technology offers a closer approximation but has not yet been sufficiently tested. Using a roll-out experimental design, this study compared client outcomes across doses of two posttraining expert consultation strategies—standard telephone consultation and live video coaching. The study was conducted during a two-state, 30-agency implementation involving 80 therapists and 330 cases receiving Parent–Child Interaction Therapy (PCIT). Child behavior problems fell from well above to below clinical cutoff values, with about a 1 standard deviation improvement in 14 sessions, which is within the range reported in laboratory efficacy trials. Symptom improvement was augmented by increased therapist dose of live video consultations. Phone consultation dose had no association with client level outcomes. PCIT benefits appear to be retained when the model is transported at scale into the field, and live video consultation appeared to offer small but significant advantages over telephone consultation as one element of an overall transport strategy.