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A Network of Services. A World of Possibilities. Parent-Child Interaction Therapy Gwen Burkholder, LCSW, CAADC [email protected] October 9, 2013. Welcome and Introductions!. Photos are courtesy of Amy Herschell , Ph.D. Thank you to the following people:.

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Presentation Transcript
welcome and introductions

Welcome and Introductions!

Photos are courtesy of Amy Herschell, Ph.D.

thank you to the following people
Thank you to the following people:
  • Cheryl Bodiford McNeil, Ph.D., Department of Psychology, West Virginia University, who provided my initial five-day training to become a PCIT clinician in November 2010
  • Amy D. Herschell, Ph. D., University of Pittsburg School of Medicine, who has provided ongoing supervision and consultation to me regarding providing PCIT in Lancaster, PA over the past three years.
what is pcit
What is PCIT?
  • Work with the parent (birth, kin, foster, adoptive) and child together
  • Designed to treat children age 2 to 7 years exhibiting disruptive behaviors
  • Use of coaching with a ‘bug-in-the-ear’ from a one-way mirror
  • Consists of two phases of treatment:
    • Relationship Enhancement
    • Behavior Management
  • Initially developed by Sheila Eyberg, University of Florida.

McNeil, C.B., & Hembree-Kigin, T. (2010). Parent-Child Interaction Therapy.Second edition. New York: Springer.

pcit set up
PCIT Set-up

Photos are courtesy of Amy Herschell, Ph.D.

what is pcit1
What is PCIT?
  • Elements of family systems, social learning theory, and traditional play therapy
  • Emphasis on restructuring parent-child patterns, not modifying target behaviors
  • Parents are not blamed, but are given responsibility for improving the child's behavior
  • Program is completed in 12-20 sessions, depending on the needs of the family
  • Empirically evaluated in over 30 controlled studies

McNeil, C.B., & Hembree-Kigin, T. (2010). Parent-Child Interaction Therapy.Second edition. New York: Springer.

critical components of pcit
Critical Components of PCIT
  • Parent and Child are seen together
  • Relationship Focused
  • Not Time Limited
  • Coaching Model – Active, Directive
  • Assessment Driven
  • Scientifically Based
  • Empirically Supported
  • Clinically Validated

Information provided by Amy Herschell, Ph. D.

who is pcit appropriate for
Who is PCIT Appropriate For?
  • Young Children (Age 2-7)
  • Children exhibiting externalizing behavior problems (e.g., verbal and physical aggression, defiance, noncompliance, temper tantrums)
  • Parents who could benefit from enhanced relationship and/or behavior management skills with young children

Information provided by Amy Herschell, Ph. D.

who is pcit appropriate for1
Who is PCIT Appropriate For?
  • Extensive contact with Primary Caregiver (or person completing PCIT with child)
  • Families with young children and who have experienced violence
  • Families with young children and relationship difficulties

Information provided by Amy Herschell, Ph. D.

developmental progression of conduct disordered behaviors
Developmental Progression of Conduct Disordered Behaviors

Oppositional

Argues Temper tantrums Bragging

Stubborn Demands attention Teases

Loud Disobeys at home Impulsive

Offensive

Cruelty Disobeys at School Fights

Sulks Screams Lying/cheating

Swears Poor peer relations

Aggressive

Destroys Bad friends Steals at home

Attacks Threatens Others

Delinquent

Sets fires Steals Outside/Home Runs away

Truancy Alcohol/drug use Vandalism

Information provided by Amy Herschell, Ph.D.

sample course of treatment
Sample Course of Treatment

Information provided by Amy Herschell, Ph. D.

assessment of appropriateness for pcit intake process
Assessment of Appropriateness for PCIT – Intake Process

Agency Intake

Supplemental PCIT Questions

Standardized, self-report measures

  • Eyberg Child Behavior Inventory (ECBI)
  • Sutter-Eyberg Student Behavior Inventory (SESBI-R)
  • Child Behavior Checklist (CBCL)
  • Parenting Stress Inventory – Short Form (PSI-SF)

Standardized, behavior observation measure

  • Dyadic Parent-Child Interaction Coding System-IV (DPICS-IV)

Information provided by Amy Herschell, Ph. D.

eyberg child behavior inventory ecbi
Eyberg Child Behavior Inventory (ECBI)
  • Assesses behaviors associated with the primary childhood disruptive behavior disorders (e.g., noncompliance, defiance, aggression)
  • Appropriate for children aged 2-16 years
  • Contains 36 items and two scales – the Intensity and Problem Scales
  • 10 Minutes for parents to complete, 2 minutes to score

Information provided by Amy Herschell, Ph. D.

child behavior checklist cbcl
Child Behavior Checklist (CBCL)
  • Survey social competencies and problem behaviors
  • Complete by parent or regular caregiver
  • Separate forms for two age groups (1.5 – 5 years & 6-18 years)
  • Approximately 100 items, 15 to 25 minutes to administer
  • Comprised of two broad band scales and a total problem scale –
      • Externalizing – disruptive or under controlled behaviors
      • Internalizing – anxiety, depression, withdrawal
      • Total problems scale

Information provided by Amy Herschell, Ph. D.

parenting stress index psi short form
Parenting Stress Index (PSI)-Short Form
  • Composed of three subscales:
    • Parental Distress
    • Dysfunctional Parent-Child Interaction
    • Difficult Child Characteristics
  • Added together, these subscales yield a Total Stress Score

Information provided by Amy Herschell, Ph. D.

dyadic parent child interaction coding system dpics
Dyadic Parent-Child Interaction Coding System (DPICS)
  • Structured observational assessment
      • Child-directed play
      • Parent-directed play
      • Clean-up
  • Observing and coding parent-child interactions for PCIT specific Skills
      • Labeled Praise, Behavioral Descriptions, Reflections
      • Questions, Commands, Criticism

Information provided by Amy Herschell, Ph. D.

recognition as an evidence based practice
Recognition as an Evidence-Based Practice

Closing the Quality Chasm in Child Abuse Treatment: Identifying and Disseminating Best Practices (Chadwick Center, 2004)     www.chadwickcenter.org/kauffman.htm

The National Child Traumatic Stress Network (Empirically Supported Treatments and Promising Practices, supported by The Substance Abuse and Mental Health Services Administration, 2005)     www.nctsn.org/nccts/nav.do?pid=ctr_top_trmnt_prom

Child Physical and Sexual Abuse: Guidelines for Treatment (Saunders, Berliner, & Hanson, Eds., National Crime Victims Research and Treatment Center and The Center for Sexual Assault and Traumatic Stress; Office for Victims of Crime, U.S. Department of Justice, 2004)

www.musc.edu/ncvc/resources_prof/OVC_guidelines04-26-04.pdf

Evidence-Based Treatment for Children and Adolescents (The Society of Clinical Child and Adolescent Psychology, a division of the American Psychological Association, and the Network on Youth and Mental Health)  www.effectivechildtherapy.com

Youth Violence: A Report of the Surgeon General (Elliott, Hatot, & Sirovatka, Eds., U.S. Department of Health and Human Services, 2001)

http://www.surgeongeneral.gov/library/youthviolence

The California Evidence-Based Clearinghouse for Child Welfare (2006)

www.cachildwelfareclearinghouse.org

Information provided by Amy Herschell, Ph. D.

kauffman best practices project 2004
Kauffman Best Practices Project (2004)

Identified Three “Best Practices” for Children who have experienced abuse and are experiencing mental health concerns:

  • Abuse-Focused CBT
  • Parent-Child Interaction Therapy
  • Trauma-Focused CBT

Information provided by Amy Herschell, Ph. D.

key research areas
Key Research Areas
  • Efficacy/Effectiveness
  • Diagnostic Classifications
  • Child Maltreatment Populations
  • Cultural Variables
  • Therapist Variables
  • Treatment Delivery
  • Attrition
  • Maintenance
  • Dissemination

Information provided by Amy Herschell, Ph.D.

treatment outcome research with children experiencing behavior problems
Treatment Outcome Research with Children Experiencing Behavior Problems

Main Findings:

  • Parent skill increases in reflective listening, physical proximity, and prosocial verbalizations
  • Decreases in sarcasm and criticism of the child
  • More positive parental attitudes toward child
  • Parent report of child behavior problems to within normal limits
  • Parent self-reported improvements in psychopathology, personal distress, and parenting locus of control
  • High consumer satisfaction with process and outcome
  • Maintenance of treatment gains up to 6 years post-treatment
  • Generalization to untreated siblings
  • Generalization to home and school
  • Herschell, A. D., Calzada, E. J., Eyberg, S. M., & McNeil, C. B. (2002). Research
  • Issues In Parent-Child Interaction Therapy. Cognitive & Behavioral Practice, 9.
studies that have demonstrated pcit s effectiveness with physical abuse
Studies that have demonstrated PCIT’s Effectiveness with Physical Abuse
  • Conceptual Stage
    • Urquiza & McNeil R21 Grant Submission (1995)
    • Urquiza & McNeil Conceptual Paper (1996)
  • Case Reports and Single Subject Designs
    • Borrego, Urquiza, Rasmussen, & Zebell (1999)
    • Fillcheck, McNeil, Herschell (in press)
    • Fricker, Ruggiero, & Smith (2005)
    • Herschell, Calzada, Eyberg, & McNeil (2002)
    • Urquiza, Timmer, Herschell, McGrath, Zebell, & Porter (2005)
  • Treatment Outcome Studies
    • Chaffin and colleages (2007, 2010)
    • Urquiza, Timmer, Zebell, & McGrath (in press)
    • McNeil, Herschell, Gurwitch, & Clemens-Mowrer (2005)

Information provided by Amy Herschell, Ph. D.

limitations and caveats
Limitations and Caveats
  • Focus on child behavioral problems, parenting skill, and changing relationships, not on all aspects of family (e.g., active substance abuse, parent psychopathology)
  • Continued need for coordination with other treatment/support agencies
  • Limited age range
  • Parent and child must have regular ongoing contact

Information provided by Amy Herschell, Ph. D.

clinician training in pcit
Clinician Training in PCIT
  • Training Requirements for Clinicians
    • Master’s degree or higher in the mental health field
    • Actively working with children and families.
    • Licensed in his or her field or receive supervision from a licensed individual trained in PCIT.
  • Training Program
    • 40-hours of face-to-face contact with a PCIT trainer
    • 4-6 months later a 2-day advanced live training
    • Case Experience (at least 2 families, preferably 5)
    • Regular (bi-weekly) consultation/Supervision over 1 year
    • Skill review

Information provided by Amy Herschell, Ph. D.

sample course of treatment1
Sample Course of Treatment

Information provided by Amy Herschell, Ph. D.

child directed interaction
Child Directed Interaction

In the effort to enhance the relationship between the parent and child, the therapist coaches the parent to do the behavioral and play therapy techniques of:

  • Reflecting what child says
  • Describing what child is doing
  • Giving specific praise for child’s positive behavior

The parent is also coached to avoid doing questions, commands, and criticism and to ignore minor annoying behavior.

parent directed interaction
Parent Directed Interaction
  • The therapist coaches the parent to gain increased compliance from the child by teaching how to give direct commands and how to follow-up with consistent consequences for non-compliance, as part of the behavioral and play therapy.
slide27
Graduation

PDI Homework Progression

Do two practice sessions of play with two siblings together

Assign at least two Public Behavior practice outings

Use PDI for House Rules

Use PDI as necessary for running commands throughout the day

Practice PDI for 2-4 carefully selected direct commands each day

After special playtime, practice PDI in a 5-min clean-up situation

Practice PDI in daily 5-10 min play situation at home

Corresponds with the Parent-Child Interaction Therapy Protocol

(2011 Edition)

how pcit has become more common in pennyslvania
How PCIT has become more common in Pennyslvania
  • The Pennsylvania Department of Public Welfare and the Pennsylvania Keys in collaboration with the Heinz Foundation, solicited Requests for Applications for Licensed Outpatient Psychiatric Clinics to send clinical staff to be trained to do Parent-Child Interaction Therapy beginning in 2010. Several cohorts of training groups have been trained since that time.
2013 pennsylvania agencies providing parent child interaction therapy
2013 Pennsylvania Agencies Providing Parent-Child Interaction Therapy

Last Updated – September 20, 2012

making referrals for pcit
Making referrals for PCIT
  • Refer to a behavioral health agency in your area who is providing PCIT.
  • Consider offering PCIT at your community health center if space is available, and the necessary licensure and billing issues can be worked out for the provision of behavioral health care on site.
recommended books on pcit
Recommended books on PCIT

Available on www.pcit.org

Available on Amazon.com

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