Jane F. Silovsky

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.

The impact of evidence-based practice implementation and fidelity monitoring on staff turnover: evidence for a protective effect.

Staff retention is an ongoing challenge in mental health and community-based service organizations. Little is known about the impact of evidence-based practice implementation on the mental health and social service workforce. The present study examined the effect of evidence-based practice implementation and ongoing fidelity monitoring on staff retention in a childrens services system. The study took place in the context of a statewide, regionally randomized effectiveness trial of an evidence-based intervention designed to reduce child neglect. In the study 21 teams consisting of 153 home-based service providers were followed over a 29-month period. Survival analyses revealed greater staff retention in the condition where the evidence-based practice was implemented along with ongoing fidelity monitoring presented to staff as supportive consultation. These results should help to allay concerns about staff retention when implementing evidence-based practices where there is good values-innovation fit and when fidelity monitoring is designed as an aid and support to service providers in providing a high standard of care for children and families.

Dynamic adaptation process to implement an evidence-based child maltreatment intervention

BackgroundAdaptations are often made to evidence-based practices (EBPs) by systems, organizations, and/or service providers in the implementation process. The degree to which core elements of an EBP can be maintained while allowing for local adaptation is unclear. In addition, adaptations may also be needed at the system, policy, or organizational levels to facilitate EBP implementation and sustainment. This paper describes a study of the feasibility and acceptability of an implementation approach, the Dynamic Adaptation Process (DAP), designed to allow for EBP adaptation and system and organizational adaptations in a planned and considered, rather than ad hoc, way. The DAP involves identifying core elements and adaptable characteristics of an EBP, then supporting implementation with specific training on allowable adaptations to the model, fidelity monitoring and support, and identifying the need for and solutions to system and organizational adaptations. In addition, this study addresses a secondary concern, that of improving EBP model fidelity assessment and feedback in real-world settings.MethodsThis project examines the feasibility, acceptability, and utility of the DAP; tests the degree to which fidelity can be maintained using the DAP compared to implementation as usual (IAU); and examines the feasibility of using automated phone or internet-enabled, computer-based technology to assess intervention fidelity and client satisfaction. The study design incorporates mixed methods in order to describe processes and factors associated with variations in both how the DAP itself is implemented and how the DAP impacts fidelity, drift, and adaptation. The DAP model is to be examined by assigning six regions in California (USA) to either the DAP (n = 3) or IAU (n = 3) to implement an EBP to prevent child neglect.DiscussionThe DAP represents a data-informed, collaborative, multiple stakeholder approach to maintain intervention fidelity during the implementation of EBPs in the field by providing support for intervention, system, and organizational adaptation and intervention fidelity to meet local needs. This study is designed to address the real-world implications of EBP implementation in public sector service systems and is relevant for national, state, and local service systems and organizations.

Characteristics of young children with sexual behavior problems: a pilot study

Sexual behavior problems (SBP) have been increasingly recognized in young children. Despite rising awareness, previous research has focused on school-age children with SBP and adolescent sex offenders. The purpose of the current study was to investigate the history, adjustment, and social environment of preschool children with SBP. Thirty-seven young children with SBP were evaluated. As expected, significant emotional and behavior problems were evident, and caregivers reported high levels of stress related to parenting. Contrary to findings among school-age samples, more of the children were female (65%) than male (35%). Many (62%) did not have substantiated histories of sexual abuse. Many children had experienced physical abuse (47%) and/or witnessed interparental violence (58%). Only four (11%) had no known history of sexual abuse, physical abuse, or witnessing domestic violence. Although further research is necessary, results supported the need to consider the developmentally unique presentation of young children with SBP.

Randomized Trial of Treatment for Children with Sexual Behavior Problems: Ten-Year Follow-Up.

This study prospectively follows 135 children 5-12 years of age with sexual behavior problems from a randomized trial comparing a 12-session group cognitive-behavioral therapy (CBT) with group play therapy and follows 156 general clinic children with nonsexual behavior problems. Ten-year follow-up data on future juvenile and adult arrests and child welfare perpetration reports were collected. The CBT group had significantly fewer future sex offenses than the play therapy group (2% vs. 10%) and did not differ from the general clinic comparison (3%), supporting the use of short-term CBT. There were no group differences in nonsexual offenses (21%). The findings do not support assumptions about persistent or difficult to modify risk and raise questions about policies and practices founded on this assumption.

Attributions and adjustment following child sexual and physical abuse

Individuals who experience child physical or sexual abuse are at greater risk for adjustment problems. However, the heterogeneity of symptomatology observed across individuals following child abuse suggests that outcome is determined by multiple factors. The authors review literature examining the relationships among childhood physical or sexual abuse, attributions, and adjustment. Implications for application and future research are discussed.

Meta-Analysis of Treatment for Child Sexual Behavior Problems: Practice Elements and Outcomes

This meta-analysis of 11 treatment outcome studies evaluated 18 specific treatments of sexual behavior problems (SBP) as a primary or secondary target. Specifically, it examines relations among child characteristics, treatment characteristics (including practice elements), and short-term outcome (including sexual and general behavior problems). Utilizing pre- and postintervention results, the overall degree of change over the course of treatment was estimated at a 0.46 and 0.49 standard deviation decline in SBP and general behavior problems, respectively. As hypothesized, the caregiver practice element Parenting/Behavior Management Skills (BPT) predicted the Child Sexual Behavior Inventory (and the Child Behavior Checklist when BPT was combined with caregiver Rules about Sexual Behaviors). In contrast, practice elements that evolved from Adult Sex Offender (ASO) treatments were not significant predictors. BPT and preschool age group provided the best model fit and more strongly predicted outcome than broad treatment type classifications (e.g., Play Therapy or Cognitive Behavior Therapy). Results question current treatments for children with SBP that are based on ASO models of treatment without caregiver involvement.

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.

Treatment for preschool children with interpersonal sexual behavior problems: a pilot study.

This pilot study evaluated a 12-week group treatment program for preschool children with interpersonal sexual behavior problems (SBP; N = 85; 53 completed at least 8 sessions). Many children presented with co-occurring trauma symptoms and disruptive behaviors. In intent-to-treat analysis, a significant linear reduction in SBP due to number of treatment sessions attended was found, an effect that was independent of linear reductions affiliated with elapsed time. Under the assumption that treatment can have an incremental impact, more than one third of the variance was accounted for by treatment effects, with female and older children most favorably impacted. Caregivers reported increase in knowledge, satisfaction, and usefulness of treatment. In addition to replication, future research is needed to examine (a) effects of environment change and time on SBP, (b) stability of treatment effects, and (c) best practices to integrate evidence-based treatments for comorbid conditions.

Change Trajectories During Home Based Services With Chronic Child Welfare Cases

This study examines how risk factor change patterns vary with case chronicity, and whether risk factor improvement still predicts lower recidivism risk among chronic cases. 2,175 parents in home based child welfare services were surveyed for risk factors at pre-treatment, post-treatment and 6-month follow-up. Mixture modeling of latent difference scores identified change trajectory classes related retrospectively to chronicity and prospectively to recidivism. Five change trajectories were identified: stable low problem, stable high problem, sustained improvement, relapsing, and paradoxical. Chronicity was associated with a decreasing probability of membership in the stable low problem trajectory and increasing probability of membership in the stable high problem and sustained improvement trajectories. Cases with more favorable trajectories recidivated less across levels of chronicity. Findings suggest that chronic cases may improve little, but still retain a stable or increasing chance of sustained improvement associated with lower risk. A cumulative service benefit might be one possible explanation for this observation, and might suggest that repeated intervention efforts are not always wasted on chronic cases. The current episodic and reactive service delivery model in child welfare may be a mismatch with chronic cases where progress is absent or tends to occur cumulatively across service episodes.