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 Pre ECBI=143 Post ECBI=105 Pre PSI=95 Post PSI=81

Bivariate Difference Score Model

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

When that Fails: Thank Goodness for PCIT