Feasibility and Preliminary Impact of a Community-Based Intervention for Maternal PTSD and Parenting: Parenting-STAIR Pilot.

Trauma exposure and post-traumatic stress disorder (PTSD) impact emotional and physical well-being, social functioning, and parent-child relationship quality. The effect of parental trauma on parenting and child maltreatment is often overlooked by current child welfare (CW) services. The novel intervention, Parenting-STAIR, was created to address maternal mental health, parenting skills, and child well-being outcomes. Parenting-STAIR is a combination of Skills Training in Affective and Interpersonal Regulation (STAIR) Narrative Therapy and Parent-Child Care (PC-CARE). This open pilot study aimed to examine the feasibility and preliminary impact of Parenting-STAIR in reducing maternal PTSD and increasing positive parenting skills for mothers and families involved in the child welfare system. Parenting-STAIR was delivered to 111 mothers receiving family preservation services in New York City. Of these, 70 completed treatment; statistical and clinically significant changes were observed for maternal PTSD and depression as well as in parenting stress, parenting skills, and child behaviors. These findings provide encouraging initial evidence for the feasibility and impact of this novel PTSD intervention. An evaluation of maltreatment recidivism is needed, as well as implementation of a randomized controlled trial to establish efficacy of the intervention.

The Long and the Short of It: A Comparison of the Effectiveness of Parent-Child Care (PC-CARE) and Parent-Child Interaction Therapy (PCIT).

Research shows that parenting interventions struggle with keeping clients in treatment. The purpose of this study was to compare attrition and rates of improvement in caregiver-child dyads participating in either Parent-Child Care (PC-CARE), a brief, 7-session parenting intervention or Parent-Child Interaction Therapy (PCIT) over a 7-week period. Participants were 204 caregiver-child dyads referred to either PC-CARE (N = 69) or PCIT (N = 135) between 2016 and 2019. Children were aged 2-7 years, referred for treatment by county Behavioral Health Services, and Medicaid funded. Findings showed that PC-CARE participants were 2.5 times more likely than PCIT participants to complete 7 sessions, all other things being equal, and showed significantly greater rates of improvement during this timeframe in reported child behavior problems and parenting stress. In conclusion, compared with PCIT, PC-CARE showed greater retention and rate of improvement in child and parent outcomes over a comparable time period.

Improving Children's Behavior in Seven Sessions: A Randomized Controlled Trial of Parent-Child Care (PC-CARE) for Children Aged 2-10 Years.

Parent-Child Care (PC-CARE) is a brief intervention for children with externalizing behaviors designed to address issues with their access to and retention in treatment. A growing evidence base of open trials and comparison studies support PC-CARE's benefits, but no randomized controlled trials (RCTs) of its effectiveness exist. The current study presents the first RCT of PC-CARE, a 7-session dyadic parenting intervention (trial number removed for blind review). Participants included a racially/ethnically diverse sample of 49 children (29% female) aged 2-10 years and their caregivers. Participants were randomly assigned to PC-CARE or waitlist control. Families participating in PC-CARE showed greater reductions in children's externalizing behaviors, improvements in children's adaptive skills, declines in parental stress, and increases in parents' positive communication skills, compared to families on the waitlist. The results of this first RCT of PC-CARE support the effectiveness of this brief intervention in improving children's behaviors.

A randomized controlled trial to assess the efficacy of Parenting-STAIR in treating maternal PTSD to reduce maltreatment recidivism: protocol for the Safe Mothers, Safe Children study.

BACKGROUND: Child maltreatment recidivism substantially increases the likelihood of adverse life outcomes, but there is little evidence that family preservation services are effective at reducing recidivism. Mothers in child welfare have very high rates of trauma exposure; maternal post-traumatic stress disorder (PTSD) is an intervention target that has the potential to reduce abuse and neglect. The Safe Mothers, Safe Children (SMSC) intervention program involves the delivery of an innovative combination of interventions, including Skills Training in Affective and Interpersonal Regulation (STAIR) and Parent-Child Interaction Therapy (PCIT). The combined intervention, Parenting-STAIR (P-STAIR), targets maternal PTSD and comorbid depression symptoms to reduce the adverse effects of PTSD on parenting, improve positive parenting skills, and prevent maltreatment recidivism. METHODS: This study is a two-arm randomized controlled trial: P-STAIR (23 sessions) versus supportive counseling (23 sessions). Participants are mothers receiving child welfare family preservation services (FPS), with a child in the age range of 1-8 years old and meeting diagnostic criteria for PTSD (with/without depression). Clinical assessment occurs at pre-treatment (baseline), two in-treatment assessments (mid-assessment #1 after module 9 and mid-assessment #2 after module 15), post-treatment, and at a 6-month follow-up. Recidivism will be measured using the New York State Child Welfare Registry (NYSCWR). We will enroll a total of 220 participants over 4 years: half (N = 110) randomly assigned to the P-STAIR condition and half (N = 110) to the supportive counseling condition. DISCUSSION: This is the first RCT to investigate the efficacy of P-STAIR. The findings for the trial have the potential to contribute to the expansion of evidence-based practices for maternal PTSD, maltreatment, and child welfare.

Testing the empirical integration of threat-deprivation and harshness-unpredictability dimensional models of adversity.

Recent dimensional models of adversity informed by a neurobiological deficit framework highlights threat and deprivation as core dimensions, whereas models informed by an evolutionary, adaptational and functional framework calls attention to harshness and unpredictability. This report seeks to evaluate an integrative model of threat, deprivation, and unpredictability, drawing on the Fragile Families Study. Confirmatory factor analysis of presumed multiple indicators of each construct reveals an adequate three-factor structure of adversity. Theory-based targeted predictions of the developmental sequelae of each dimension also received empirical support, with deprivation linked to health problems and cognitive ability; threat linked to aggression; and unpredictability to substance use and sexual risk-taking. These findings lend credibility to utility of the three-dimensional integrative framework of adversity. It could thus inform development of dimensional measures of risk assessment and exploration of multidimensional adversity profiles, sensitive to individual differences in lived experiences, supporting patient-centered, strength-based approaches to services.

Train-to-Sustain: Predictors of Sustainment in a Large-Scale Implementation of Parent-Child Interaction Therapy.

Sustainment of evidence-based practices is necessary to ensure their public health impact. The current study examined predictors of sustainment of Parent-Child Interaction Therapy (PCIT) within a large-scale system-driven implementation effort in Los Angeles County. Data were drawn from PCIT training data and county administrative claims between January 2013 and March 2018. Participants included 241 therapists from 61 programs. Two sustainment outcomes were examined at the therapist- and program-levels: 1) PCIT claim volume and 2) PCIT claim discontinuation (discontinuation of claims during study period; survival time of claiming in months). Predictors included therapist- and program-level caseload, training, and workforce characteristics. On average, therapists and programs continued claiming to PCIT for 17.7 and 32.3 months, respectively. Across the sustainment outcomes, there were both shared and unshared significant predictors. For therapists, case-mix fit (higher proportions of young child clients with externalizing disorders) and participation in additional PCIT training activities significantly predicted claims volume. Furthermore, additional training activity participation was associated with lower likelihood of therapist PCIT claim discontinuation in the follow-up period. Programs with therapists eligible to be internal trainers were significantly less likely to discontinue PCIT claiming. Findings suggest that PCIT sustainment may be facilitated by implementation strategies including targeted outreach to ensure eligible families in therapist caseloads, facilitating therapist engagement in advanced trainings, and building internal infrastructure through train-the-trainer programs.

Long-term mental health services use in children referred to a clinical intervention.

BACKGROUND: Recent advancements in pediatric mental health (MH) increased accessibility of evidence-based interventions. Yet, accessibility alone does not explain the rise in MH services use (MHSU). Maltreatment-related adversity, symptom severity, and access to early interventions have been linked to ongoing need for services, yet their joint contributions to continuities in MHSU remain unclear. OBJECTIVE: The study examines the role of maltreatment, externalizing symptom severity, and referral for early intervention in pediatric MHSU across five years. To evaluate engagement in treatment, we accounted for treatment progress and referral type, comparing MHSU in court-mandated and voluntary participants. PARTICIPANTS AND SETTING: Participants were 321 children (M = 4.3 years; 58.9 % boys) referred to parent-child interaction therapy (PCIT), an evidence-based intervention for families struggling with child disruptive behaviors and maltreating families involved with child welfare. Services were provided at a university-affiliated clinic in a metropolitan county. METHOD: Symptom severity was assessed with standardized questionnaires; maltreatment history and referral type were obtained from casefile reviews. MHSU was tracked through county behavioral health diagnostic reports. The data were analyzed using structural equation modeling. RESULTS: Results indicated that for the 44.9 % of children with onward referrals, the frequency of service use, but not progress in treatment, predicted ongoing services. Maltreatment emerged as a universal predictor, while externalizing predicted MHSU only in court-mandated participants, suggesting referral type contributes to quantifiable differences in MH needs. CONCLUSIONS: Findings emphasize importance of ongoing funding for pediatric MH services, and the need to explore mechanisms underlying continuous MHSU in vulnerable children.

Improved Perceptions of Emotion Regulation and Reflective Functioning in Parents: Two Additional Positive Outcomes of Parent-Child Interaction Therapy.

The purpose of this study was to test whether Parent-Child Interaction Therapy (PCIT), a widely used effective therapy for children's externalizing behaviors and parenting problems, was associated with improvements in parents' emotion regulation and reflective functioning. We also investigated whether these improvements had unique associations with children's improvements in externalizing and internalizing symptoms. Participants were 139 Australian children aged 29 to 83 months and their caregivers; all were referred for child externalizing behavior problems coupled with parenting skill deficits or high parent stress. All data were gathered via a questionnaire completed prior to and after completion of PCIT. Significant improvements were found in parents' self-reported emotion dysregulation and capacity to use cognitive reappraisal for emotion regulation. There was also improvement in parents' self-report of children's symptoms, parenting practices, and reflective functioning in the form of prementalizing, which measured a low capacity to understand the emotional world of the child. Multiple regression showed that improvements in cognitive reappraisal, prementalizing, and negative parenting practices were associated with improvement in children's symptoms. The findings extend the existing evidence for PCIT as an effective parenting intervention, adding parents' perceived emotion regulation and reflective functioning to the list of positive outcomes from PCIT. Improved emotion regulation and reflective functioning, unique from changes in parenting practices, could be mechanisms that help explain why PCIT has been associated with improvements in children's externalizing behaviors.

An Open Trial of Parent-Child Care (PC-CARE)-A 6-Week Dyadic Parenting Intervention for Children with Externalizing Behavior Problems.

Research shows that parenting interventions are plagued with the problem of early treatment termination. A brief 6-week intervention, parent-child care (PC-CARE) was developed to minimize the time investment for parents while maximizing the probability of improving behavioral problems of their 1-10 year old children. The purpose of this study was to determine the feasibility of PC-CARE and examine preliminary outcomes. The data were collected as part of an open trial in a community mental health clinic and included pre- and post-treatment performance outcomes, weekly measures of treatment progress, and assessments of treatment fidelity. Participants were 64 children and their primary caregivers, referred by physicians, social workers, or self-referred for help with their children's difficult behaviors. The retention rate was 94%. Results of analyses pre- to post-intervention scores showed significant improvements in child behavioral problems as well as improvements in parenting stress and positive parenting skills. The findings suggest that PC-CARE may be a beneficial treatment for children with disruptive behaviors, encourage future research into the efficacy of this brief parenting intervention, and its effectiveness in other populations and contexts.

Specialized Behavioral Therapies for Children with Special Needs.

This article describes common mental health problems in children and adolescents, and the types of specialized, evidence-based treatments that are most effective in treating these needs. The value of using an evidence-based treatment is now widely acknowledged, and the number of interventions with empirical support is increasing. This article provides an overview of the effects of trauma on developing children, with an emphasis on common maladaptive responses in infancy, toddlerhood, young childhood, middle childhood, and adolescence. This is followed by descriptions of several well-researched interventions that have the greatest utility for each distinct phase of child development.

Parent-Child Interaction Therapy for sexual concerns of maltreated children: A preliminary investigation.

The current study examines whether an evidence-based treatment for externalizing behavior problems may reduce sexual concerns among children with maltreatment histories. An archival analysis identified 44 children between the ages of 3 and 8 exhibiting externalizing problems and co-morbid sexual concerns who were treated using Parent-Child Interaction Therapy (PCIT). A second group of children receiving PCIT for externalizing behaviors without sexual concerns was included for comparison purposes (n=143). Wilcoxon Signed-Ranks Tests indicated significant improvement among the group with sexual concerns, with 63.6% of children no longer displaying clinically significant sexual concerns at post-treatment. In addition, these children showed a decline in general externalizing problems comparable to that observed among the group of children receiving PCIT and not displaying sexual concerns. Lastly, logistic regression analyses showed that pre-treatment posttraumatic stress scores did not moderate improvement of sexual concerns, suggesting that posttraumatic stress-related sexual concerns may improve from PCIT treatment. These findings suggest that evidence-based parent training interventions, specifically PCIT, may successfully reduce sexual concerns among children who experienced maltreatment.

Filling potholes on the implementation highway: Evaluating the implementation of Parent-Child Interaction Therapy in Los Angeles County.

In October 2012, first 5 LA funded a unique collaboration between Los Angeles County Department of Mental Health (DMH) and UC Davis PCIT Training Center (UCD PCIT) to train county-contracted agencies to provide Parent-Child Interaction Therapy (PCIT). This $20 million dollar, 5-year grant represented the largest implementation effort of an empirically based treatment to date. The purpose of this paper was to describe the first 2 years of the implementation process of this project, beginning with project start up and pre-implementation phases, and to present agency training and client performance outcomes from our first year of training. Results presented in this evaluation suggest that it is possible to train LA County providers in PCIT, and that PCIT is an effective intervention for DMH-contracted providers in LA County. This evaluation also discusses challenges to successful implementation. Barriers to progress included unanticipated delays building county infrastructure, trainee attrition, and insufficient client referrals. We discuss the results of the current implementation with respect to theory, research, and others' training models, with the aim of evaluating and prioritizing different implementation drivers, noting the ongoing competition between knowing what to do and the need for action.

Coping style and memory specificity in adolescents and adults with histories of child sexual abuse.

Individuals with histories of childhood trauma may adopt a nonspecific memory retrieval strategy to avoid unpleasant and intrusive memories. In a sample of 93 adolescents and adults with or without histories of child sexual abuse (CSA), we tested the hypothesis that nonspecific memory retrieval is related to an individual's general tendency to use avoidant (i.e., distancing) coping as a personal problem-solving or coping strategy, especially in victims of CSA. We also examined age differences and other individual differences (e.g., trauma-related psychopathology) as predictors of nonspecific memories. Distancing coping was significantly associated with less specific autobiographical memory. Younger age, lower vocabulary scores, and non-CSA childhood maltreatment (i.e., physical and emotional abuse) also uniquely predicted less autobiographical memory specificity, whereas trauma-related psychopathology was associated with more specific memory. Implications for the development of autobiographical memory retrieval in the context of coping with childhood maltreatment are discussed.

Autobiographical memory specificity in child sexual abuse victims.

The present study examined the specificity of autobiographical memory in adolescents and adults with versus without child sexual abuse (CSA) histories. Eighty-five participants, approximately half of whom per age group had experienced CSA, were tested on the autobiographical memory interview. Individual difference measures, including those for trauma-related psychopathology, were also administered. Findings revealed developmental differences in the relation between autobiographical memory specificity and CSA. Even with depression statistically controlled, reduced memory specificity in CSA victims relative to controls was observed among adolescents but not among adults. A higher number of posttraumatic stress disorder criteria met predicted more specific childhood memories in participants who reported CSA as their most traumatic life event. These findings contribute to the scientific understanding of childhood trauma and autobiographical memory functioning and underscore the importance of considering the role of age and degree of traumatization within the study of autobiographical memory.

Parent-child interaction therapy: Enhancing parent-child relationships / Un programa para la mejora de las relaciones padres-hijos. La terapia de interacción padres-hijos

Disruptive child behavior problems are common problems for parents and can be associated with serious delinquent behaviors and aggressive/violent behaviors in adolescence and adulthood. Parenting interventions to address disruptive child behavior problems has gained widespread acceptance. One of these parenting interventions is Parent-Child Interaction Therapy (PCIT). PCIT is a 14- to 20-week, founded on social learning and attachment theories, designed for children between 2 and 7 years of age with disruptive, or externalizing, behavior problems. This article will provide a brief review of the history of PCIT, a description of the basic components of PCIT, and an overview of recent developments that highlight the promise of PCIT with maltreating parent-child relationships, traumatized children, and in developing resilience in young children. In addressing the three basic treatment objectives for PCIT (i.e., reduction in child behavior problems, improving parenting skills, enhancing the quality of parent-child relationships), there is an abundance of research demonstrating very strong treatment effects and therefore, its value to the field. Recent research has also demonstrated the value of PCIT in reducing trauma symptoms in young children (AU)

Los problemas de comportamiento infantil disruptivo son frecuentes para muchos padres y pueden estar asociados con graves conductas delictivas o agresivas/violentas en la adolescencia o en la edad adulta. Las intervenciones con los padres que tratan este tipo de problemas de comportamiento disruptivo han ganado aceptación. Unos de estos programas de intervención con los padres es la Terapia de Interacción Padres-Hijos (PCIT). El PCIT es un programa, basado en las teorías del apego y del aprendizaje social, diseñado para niños y niñas de entre 2 y 7 años de edad que presenten problemas de conducta disruptiva o externalizados, y que tiene una duración de entre 14 y 20 semanas. En este artículo se presentará una breve revisión de la historia del PCIT, una descripción de sus componentes básicos, y una visión general de los avances recientes que subrayan las posibilidades del PCIT para mejorar las relaciones padres-hijos en familias maltratantes, para tratar a niños y niñas víctimas de situaciones traumáticas y para mejorar la resiliencia en niños y niñas de corta edad. En relación con los tres objetivos básicos del PCIT (es decir, reducción de los problemas de conducta, mejora de las habilidades parentales y mejora de la calidad de las relaciones entre padres e hijos), hay una abundancia de investigaciones que demuestran robustos efectos del tratamiento y, por tanto, su validez para ser aplicado de manera generalizada. La investigación más reciente ha demostrado también el valor de PCIT en la reducción de síntomas traumáticos en niños y niñas de corta edad (AU)

Mothers' physical abusiveness in a context of violence: effects on the mother-child relationship.

The purpose of this study was to investigate the effects of mothers' physical abusiveness on the quality of the mother-child relationship, and note how it further varied by their exposure to interparental violence (IPV). The sample consisted of 232 clinic-referred children, aged 2 to 7 years, and their biological mothers. Slightly more than a quarter of the children (N = 63, 27.2%) had been physically abused by their mothers; approximately half of these children also had a history of exposure to IPV (N = 34, 54%). Investigating effects of physical abuse in the context of IPV history on mothers' and children's emotional availability, we found that physically abused children with no IPV exposure appeared less optimally emotionally available than physically abused children with an IPV exposure. However, subsequent analyses showed that although dyads with dual-violence exposure showed emotional availability levels similar those of nonabusive dyads, they were more overresponsive and overinvolving, a kind of caregiving controllingness charasteric of children with disorganized attachment styles. These findings lend some support to the notion that the effects of abuse on the parent-child relationship are influenced by the context of family violence, although the effects appear to be complex.

The effectiveness of parent-child interaction therapy with depressive mothers: the changing relationship as the agent of individual change.

This study uses a multi-method approach to investigate the effectiveness of Parent-Child Interaction Therapy (PCIT) in reducing children's behavior problems when parents report clinical levels of depressive symptoms. Participants were 132 children, 2-7 years of age, and their biological mothers, who either reported low (N = 78) or clinical levels of depressive symptoms (N = 54). Results showed that depressive mothers were likely to report more severe child behavior problems than non-depressive mothers at the pre-treatment assessment, but that depressive mothers reported greater reductions in child behavior problems than non-depressive mothers from pre- to post-treatment. The two groups showed similar levels of observed interaction quality at the pre-treatment assessment (i.e., parent and child emotional availability and parent verbalization patterns) and similar improvements in interaction quality from pre- to post-treatment. The implications of the findings for clinical practice were discussed.

False memory for trauma-related Deese-Roediger-McDermott lists in adolescents and adults with histories of child sexual abuse.

The purpose of the present research was to examine Deese-Roediger-McDermott false memory for trauma-related and nontrauma-related lists in adolescents and adults with and without documented histories of child sexual abuse (CSA). Individual differences in psychopathology and adult attachment were also explored. Participants were administered free recall and recognition tests after hearing CSA, negative, neutral, and positive Deese-Roediger-McDermott lists. In free recall, CSA and negative lists produced the most false memory. In sharp contrast, for recognition, CSA lists enjoyed the highest d' scores. CSA-group adolescents who evinced greater posttraumatic stress disorder (PTSD) symptoms had higher rates of false memory compared to (a) non-CSA group adolescents with higher PTSD symptom scores (free recall), and (b) CSA-group adolescents with lower PTSD symptom scores (recognition). Regression analyses revealed that individuals with higher PTSD scores and greater fearful-avoidant attachment tendencies showed less proficient memory monitoring for CSA lists. Implications for trauma and memory development and for translational research are discussed.

The effectiveness of parent-child interaction therapy for victims of interparental violence.

This study compares the effectiveness of Parent-Child Interaction Therapy (PCIT) in reducing behavior problems (e.g., aggression, defiance, anxiety) of 62 clinic-referred, 2- to 7-year-old, maltreated children exposed to interparental violence (IPV) with a group of similar children with no exposure to IPV (N=67). Preliminary analyses showed that IPV-exposed dyads were no more likely to terminate treatment prematurely than non IPV-exposed dyads. Results of repeated-measures MANCOVAs showed significant decreases in child behavior problems and caregivers' psychological distress from pre- to posttreatment for IPV-exposed and IPV nonexposed groups, and no significant variation by exposure to IPV. Stress in the parent role related to children's difficult behaviors and the parent-child relationship decreased from pre- to posttreatment, but parental distress did not decrease significantly over the course of PCIT. Results of an analysis testing the benefits of a full course of treatment over the first phase of treatment showed that dyads completing the full course of treatment reported significantly greater improvements in children's behavior problems than those receiving only the first phase of treatment.

Evaluation of a treatment manual and workshops for disseminating, parent-child interaction therapy.

This study's main purposes were to: (a) evaluate a treatment manual as a dissemination strategy, (b) compare two workshop formats for evidence-based treatment (EBT) training, and (c) provide preliminary data on therapist characteristics potentially associated with successful EBT adoption. Forty-two community-based clinicians were assigned to one of two training groups (didactic or experiential). Behavior observation and self-report data were collected at four time points. Results suggest that reading a treatment manual is useful, but not sufficient. Experiential and didactic training were equally effective in increasing knowledge, skill, and satisfaction; however, after a 2-day training, few participants demonstrated mastery of skills.