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.

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.

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.

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.

Parent-child interaction therapy: application of an empirically supported treatment to maltreated children in foster care.

One of the more serious problems faced by child welfare services involves the management of children with serious behavioral and mental health problems. Aggressive and defiant foster children are more likely to have multiple foster care placements, require extraordinary social services resources, and have poor short- and long-term mental health outcomes. Interventions that work with challenging foster children and enhance foster parents' skills in managing problem behaviors are necessary. This article presents the successful results of a single case study examining the application of Parent-Child Interaction Therapy (PCIT) with an aggressive young boy and his foster-adoptive parent. PCIT is a dyadic intervention that has been identified as an empirically supported treatment for abused children and for children with different types of behavioral disruption. The application of PCIT to assist foster parents is a promising direction for child welfare services.

Parent-child interaction therapy: application to maltreating parent-child dyads.

OBJECTIVE: Parent-Child Interaction Training (PCIT), which uses a social learning framework, is a dyadic intervention that is designed to alter specific patterns of interaction found in parent-child relationships. Previous research suggests that maladaptive and high-risk characteristics found in maltreating parent-child dyads may be responsive to PCIT. The primary focus of this study is to examine the effectiveness of PCIT with maltreating parent-child dyads. METHODOLOGY: This study describes the effectiveness of PCIT with 136 biological parent-child dyads in which 66.9% (N=91) of the children had been maltreated. Of the 91 maltreated children, 64.8% (N=59) of the parents had maltreated their children, and were thus considered to be at high risk of repeating the abuse. RESULTS: Primary outcomes of this study show the following: (1) a decrease in child behavior problems, (2) a decrease in parental stress, and (3) a decrease in abuse risk from pre- to post-treatment for dyads with and without a history of maltreatment. CONCLUSIONS: Our results add to the body of research supporting PCIT as a promising intervention and as a means to aid both children and parents in high-risk families for maltreatment.

Physically abusive mothers' responses following episodes of child noncompliance and compliance.

The authors used sequential analysis to examine specific interaction patterns between physically abusive mothers and their children following episodes of noncompliance and compliance. Fifteen abusive and 15 nonabusive, low-risk mother-child dyads were observed, and their behaviors were coded for specific interactions. The children in the study ranged in age from 2 to 6 years. Results indicated that after noncompliance occurred, physically abusive mothers were more likely than nonabusive mothers to respond negatively and give another command. When child compliance occurred, there were no group differences in the likelihood of praising their children's prosocial behavior, but physically abusive mothers were less likely than nonabusive mothers to engage in other forms of positive behavior (e.g., positive touch) after compliance. Clinical implications are discussed in the context of working with physically abusive families.

Challenging children in kin versus nonkin foster care: perceived costs and benefits to caregivers.

This study uses social exchange theory as a framework for examining 102 kin and 157 nonkin foster parents' perceptions of their foster children, their relationships with them, and their own functioning. The authors argue that these perceptions reflect perceived costs and benefits of parenting these children, which may influence their investment in them. All children in the study were referred to Parent-Child Interaction Therapy (PCIT) for treatment of the children's behavior problems, participating with their foster parents. Analyses showed that nonkin caregivers rated their foster children's behavior problems as significantly more severe than kin caregivers but rated themselves as significantly less stressed. Analyses predicting early treatment termination showed that kin caregivers were more likely than nonkin caregivers to complete the course of treatment in PCIT, particularly if they reported elevated levels of parental distress. The authors discuss the implications of these findings for foster children's placement stability and long-term success.