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Group Parent-Child Interaction Therapy: Application to Children with Prenatal Substance Exposure Robin H. Gurwitch, Ph.D. Vicki Cook, M.Ed. Mark Chaffin, Ph.D. David Bard, M.S. Matt Grim, M.S. Beverly W. Funderburk, Ph.D. University of Oklahoma Health Sciences Center Department of Pediatrics
Rationale for Group Format • Too many referrals, too few therapists • Attrition • Time efficiency • Cost efficiency • Vicarious learning opportunities • Increased generalization opportunities • Feedback and praise from others • Support group for caregivers
Group Application • Traditional PCIT Families • Families in Substance Abuse Treatment Centers • Families with children with FASD/other substance exposure in clinical setting
Caregivers of Children with Prenatal Exposure • Perceptions of the child are negative • Parenting satisfaction is lower than those w/o substance exposure • Higher levels of parenting stress • Increased risk for attachment problems and failed placements • Increased risk of relapse
Rationale for Applying PCIT to Prenatal Substance Exposure • Many unrewarding child behaviors associated with prenatal substance exposure • Increased risk for behavioral difficulties as secondary disabilities • Hyperactivity • Inattention • Poor Impulse Control • Problems with compliance • Increased risk for parenting stress • Increased risk for failed placement
Rationale for Applying PCIT to Prenatal Substance Exposure • Parents perceive children as behaviorally disordered solely due to drug/alcohol exposure • They are more receptive to an approach offering effective behavior management • Needs of caretakers with children considered “at risk” are consistent with the skill training focus of PCIT
Population • Child • Diagnosed with FASD or other substance exposure • Functioning at a minimum of 30 months of age in cognitive development • Between 2 ½ and 7 years of age • Parent/Caregiver • >65 IQ based on KBIT
Measures • Developmental measures (e.g., Bayley Scales of Infant Development-II; WPPSI-R) • Genetics evaluation • ECBI • PSI • DPICS-II
Progression of Group PCIT Treatment • 15 weeks of treatment • Session 1: Education about substance abuse and child development and advocacy • Session 2: Introduction to PCIT and group intake session • Session 3: Individual intake session and DPICS • Session 4: CDI Didactic • Sessions 5-7: CDI coaching sessions (specific skill goals and homework for each family)
Progression of Group PCIT Treatment • Session 8: PDI Didactic • Sessions 9-13: PDI coaching sessions (specific skill goals and homework for each family) • Session 12: House Rules and Generalization session with all families • Session 13: Public Behavior and Generalization session with all families • Session 14: Managing Future Behaviors and Termination • Session 15: Post-treatment assessment • Follow-up sessions (6, 12, 18 months)
Results of PCIT with Children with Prenatal Substance Exposure (n=38)
New Model for Data Analysis • N=93 • Pre ECBI=143 • Post ECBI=105 • Pre PSI=95 • Post PSI=81
Next Steps:Dissemination in the Community • Stakeholder buy-in • Commitment from community sites • Training of licensed mental health professionals • One week (40 hours) • Six weeks later (16 hours): Focus on PDI • On-going consultation (random assignment) • Phone • Phone + Live videotechnology consultation • Videotape submissions • Data collection (DPICS, weekly ECBI, PSI at each treatment phase)
Continued Challenges • Drop-out • Foster care placement issues • Reunification and substance abuse • Transportation • Even if treatment is 100% effective—the child still has FASD/other prenatal substance exposure
Funding to Help Us Keep Looking for Answers • Centers for Disease Control and Prevention (CDC) • Oklahoma Department of Substance Abuse and Mental Health Services • Native American Research Centers for Health (NIH) • Oklahoma Department of Human Services