A Community Mental Health Implementation of Parent–Child Interaction Therapy (PCIT)

Abstract

Parent-Child Interaction Therapy (PCIT) has been identified as an evidence-based practice in the treatment of externalizing behavior among preschool-aged youth. Although considerable research has established its efficacy, little is known about the effectiveness of PCIT when delivered in a community mental health setting with underserved youth. The current pilot study investigated an implementation of PCIT with primarily low-socioeconomic status, urban, ethnic minority youth and families. The families of 14 clinically referred children aged 2–7 years and demonstrating externalizing behavior completed PCIT initial assessment, and 12 began treatment. Using standard PCIT completion criteria, 4 families completed treatment; and these families demonstrated clinically significant change on observational and self-report measures of parent behavior, parenting stress, and child functioning. Although treatment dropouts demonstrated more attenuated changes, observational data and parent-reported problems across sessions indicated some improvements with lower doses of intervention. Attendance and adherence data, referral source, barriers to treatment participation, and treatment satisfaction across completers and dropouts are discussed to highlight differences between the current sample and prior PCIT research. The findings suggest that PCIT can be delivered successfully in an underserved community sample when families remain in treatment, but that premature dropout limits treatment effectiveness. The findings suggest potential directions for research to improve uptake of PCIT in a community service setting.

Parent–Child Interaction Therapy: A Meta-Analysis of Child Behavior Outcomes and Parent Stress

“…Originally, PCIT was intended for use with preschool age children, but it is becoming more widely used with many different populations and wider age ranges of children with externalizing behavior problems (Eyberg, 1988). Populations that have been treated with PCIT interventions include oppositional preschoolers and early school-age children (Boggs et al, 2004;Lyon & Budd, 2010;Nixon, Sweeney, Erickson, & Touyz, 2004;Phillips, Morgan, Cawthorne, & Barnett, 2008;Ware, McNeil, Masse, & Stevens, 2008), foster children with kin or nonkin caregivers (McNeil, Herschell, Gurwitch, & Clemens-Mowrer, 2005;Timmer, Urquiza, & Zebell, 2006), maltreated child-parent dyads (Chaffin et al, 2004;Timmer, Sedlar, & Urquiza, 2004;Timmer, Urquiza, Zebell, & McGrath, 2005), children on the autism spectrum (Soloman, Ono, Timmer, & Goodlin-Jones, 2008), children with mental retardation (Bagner & Eyberg, 2007), children with behavior problems who were born prematurely (Bagner, Sheinkopf, Vohr, & Lester, 2010), and ethnically diverse populations and international samples (Leung, Tsang, Heung, & Yiu, 2009;McCabe & Yeh, 2009;Phillips et al, 2008). Thomas and Zimmer-Gembeck (2007) suggested a need for studies focused on the dissemination and portability of PCIT to minority and limitedresource populations in community settings, following the establishment of this intervention as an efficacious treatment among moderate and highincome families.…”

Treatment Outcomes for At-Risk Young Children With Behavior Problems: Toward a New Definition of Success

“…This method offers a logically valid and highly reliable measure of client improvement during treatment (Swift et al, 2009). By combining these two components, namely, a minimum length of treatment combined with a reliable change index, PCT programs can measure both participation in treatment and reduction in child behavior The fourth program, PCIT, required three criteria for treatment completion: (a) the child participant must score below a cutoff on a self-report measure of child behavior problems, (b) the caregiver and clinician must agree that the caregiver is prepared to independently manage the child's behavior, and (c) the caregiver must meet a specified level of mastery for program activities (Lyon & Budd, 2010). As a result of these differing definitions, reports of child and family attrition percentages are highly variable.…”

Evaluation of a University-Community Partnership to Provide Home-Based, Mental Health Services for Children from Families Living in Poverty

“…These early intervention programs, which consist largely of cognitive-behavioral procedures that are developmentally appropriate for toddlers and preschoolers, have significantly reduced early childhood behavior problems (Brinkmeyer & Eyberg, 2003;Nicholson, Anderson, Author, & Brenner, 2002;Webster-Stratton, 1994). The treatment efficacy research for these early intervention programs is relatively new and initial studies have been conducted in well-controlled, laboratory or clinic-based studies (Lyon & Budd, 2010). The next and more difficult step is to determine the effectiveness of these treatment programs in community-based, mental health centers that typically serve more at-risk populations of children.…”