Early intervention for families experiencing homelessness: A pilot randomized trial comparing two parenting programs.

Abstract

Objective: As part of a larger community-based, service-driven research project, the primary purpose of this pilot randomized study was to examine the feasibility and acceptability of delivering time-limited adaptations of parent-child interaction therapy (PCIT) and child-parent psychotherapy (CPP) within a sample of children experiencing homelessness. The secondary goal was to examine the promise of both interventions in improving parent/child outcomes. Method: One hundred forty-four young children (18 month-5 years old; M age = 3.48, SD = 1.09; 43.1% female; 78.5% Black/African American; 27.1% Hispanic) and their mothers were recruited from a women's homeless shelter and randomly assigned to 12 weeks of either PCIT or CPP delivered by shelter clinicians on-site. Attendance, fidelity, and program satisfaction were obtained. Families completed pre-and postintervention assessments, including observational data on maternal verbalizations during a child-led play session. Results: Both time-limited PCIT and time-limited CPP were successfully implemented with similarly high levels of intervention fidelity (>90%) and satisfaction by mothers (85%). Completion rates were similar across both time-limited PCIT (76.6%) and time-limited CPP (71.4%). Both time-limited CPP and PCIT resulted in decreases in children's posttraumatic stress, parental stress, and increases in maternal positive verbalizations. Only time-limited PCIT resulted in significant improvements in externalizing behavior problems in children and reductions in maternal negative verbalizations. Conclusions: Time-limited PCIT and CPP are acceptable, feasible, and hold significant promise for helping families within a homeless shelter environment and by extension, other transitional and/or shelter environments. A full randomized trial is warranted to determine which program may offer a more effective intervention. What is the public health significance of this article?This study shows how a service-driven, community-university partnership can play a large role in addressing the mental health needs of sheltered children and families by identifying their clinical needs and showing the feasibility, acceptability, and promise of providing evidence-based early intervention programs within a shelter setting. Time-limited versions of well-established early intervention programs like parent-child interaction therapy (PCIT) and child-parent psychotherapy (CPP) were feasible to implement and well-accepted by families. Both PCIT and CPP hold significant promise for helping families within a homeless shelter. A larger future randomized trial is warranted to determine whether PCIT may offer a more effective intervention targeting externalizing behavior problems and parenting relative to CPP.

Interventions to improve the mental health of women experiencing homelessness: A systematic review of the literature

“…Both completers and non-completers reported high levels of satisfaction at mid-treatment, and at post-treatment, completers continued to report high levels of satisfaction. Women who participated in Parent–child interaction therapy (PCIT) and Child–parent psychotherapy (CPP) [ 80 ] reported high levels of overall satisfaction across both interventions noting greatest improvements in their parent–child relationship, feeling like their child made progress in terms of their general behaviour, progress related to their trauma symptoms or traumatic/stressful experiences, and generally positive feelings about the parenting programs. Over 90% indicated that they would likely recommend both programmes to others.…”

“…Parenting interventions resulted in an improvement in psychological symptoms relative to baseline in two studies, and deterioration of symptoms in another study [ 71 , 72 , 80 ]. There is a small body of literature evaluating parenting interventions in homeless populations, most studies are methodologically weak, and outcomes generally relate to child behaviour and parenting skills, as opposed to parental mental health.…”

“…Parenting interventions. Three studies of different parenting interventions reported on psychological symptom severity and psychological distress, with limited evidence of effectiveness at immediate post-testing [71,72,80]. In one study of a bonding and reflexivity intervention for sheltered homeless mothers with infants, when psychological distress was measured post-intervention, scores worsened slightly in both control and intervention groups, with no significant differences between groups [71].…”

“…There were no additional measurement time points. In a study comparing Parent-child interaction therapy (PCIT) and Child-parent psychotherapy (CPP) [80] significant reduction of parenting stress was observed in both groups, however there was no follow-up to confirm the durability of this effect. [43][44][45][46]81].…”