Parent-Child interaction therapy (PCIT) has been shown to improve positive, responsive parenting and lower risk for child maltreatment (CM), including among families who are already involved in the child welfare system. However, higher risk families show higher rates of treatment attrition, limiting effectiveness. In N = 120 child welfare families randomized to PCIT, we tested behavioral and physiological markers of parent self-regulation and socio-cognitive processes assessed at pre-intervention as predictors of retention in PCIT. Results of multinomial logistic regressions indicate that parents who declined treatment displayed more negative parenting, greater perceptions of child responsibility and control in adult–child transactions, respiratory sinus arrhythmia (RSA) increases to a positive dyadic interaction task, and RSA withdrawal to a challenging, dyadic toy clean-up task. Increased odds of dropout during PCIT's child-directed interaction phase were associated with greater parent attentional bias to angry facial cues on an emotional go/no-go task. Hostile attributions about one's child predicted risk for dropout during the parent-directed interaction phase, and readiness for change scores predicted higher odds of treatment completion. Implications for intervening with child welfare-involved families are discussed along with study limitations.

Background: Child maltreatment (CM) constitutes a serious public health problem in the United States with parents implicated in a majority of physical abuse and neglect cases. Parent-Child Interaction Therapy (PCIT) is an intensive intervention for CM families that uses innovative "bug-in-ear" coaching to improve parenting and child outcomes, and reduce CM recidivism; however, the mechanisms underlying its effects are little understood. The Coaching Alternative Parenting Strategies (CAPS) study aims to clarify the behavioral, neural, and physiological mechanisms of action in PCIT that support positive changes in parenting, improve parent and child self-regulation and social perceptions, and reduce CM in child welfare-involved families.

Objective: We conducted a large (N = 204) randomized, clinical trial to test the efficacy of Parent-Child Interaction Therapy (PCIT) on observed parenting and two key drivers of maladaptive parenting— self-regulation skills and harsh social cognitions—in a sample of child welfare-involved families. Method: Participants were randomly assigned to receive standard PCIT (n = 120) or services-as-usual (SAU; n = 84). The sample was characterized by low household income and significant exposures to adverse childhood experiences (ACEs) and substance abuse. Intention-to-treat analyses were conducted on multiply-imputed data followed by secondary per-protocol analyses. Results: Significant PCIT effects emerged on (a) increased positive parenting and reduced negative parenting (small-to-medium ITT effects and medium-to-large per-protocol effects); (b) gains in inhibitory control performance on the stop-signal task (small-to-medium ES); (c) gains in parent-reported emotion regulation and (d) positive, affirming self-perceptions (small-to-medium ES), relative to SAU control. The effects of PCIT on gains in parent emotion regulation were mediated by reductions in observed negative parenting. No main effects were observed on parent RSA scores or child attributions. Harsh child attributions moderated treatment response: PCIT parents who held the harshest child attributions displayed the greatest gains in labelled praises and declines in negative talk/criticism. Conclusions: This randomized trial presents the first evidence that PCIT improves inhibitory control and emotion regulation in child welfare-involved parents and provides independent replication of other published trials documenting gains in observed parenting.

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Objective: We tested the efficacy of standard Parent–Child Interaction Therapy (PCIT), a live-coached, behavioral parent-training program, for modifying problematic eating behaviors in a larger effectiveness trial of PCIT for children involved in the child welfare system. Method: Children ages 3–7 years and their parents were randomly assigned to PCIT intervention (n = 120) or services as the usual control (SAU; n = 84) groups in a randomized clinical trial. Children’s eating behaviors were assessed pre- and post-intervention via the Child Eating Behaviors Questionnaire (CEBQ). Intention-to-treat analyses were conducted, followed by per-protocol analyses, on treatment-engaging families only. Results: PCIT led to reductions in child welfare-involved children’s food responsiveness, speed of food consumption, and tendency to engage in emotional overeating relative to children in the services-as-usual control condition. Standard PCIT may be an effective intervention to promote healthy child eating behaviors in families involved with child welfare, even when food-related behaviors are not directly targeted by the intervention. Public Health Significance: This clinical trial provides evidence that child welfare-involved children who received PCIT experienced significant reductions in maladaptive eating-related behaviors, namely food responsiveness, emotional overeating, and speed of eating. These findings were observed in relation to children in a comparison control group who had access to child welfare services-as-usual.