Parent-Child Interaction Therapy: Applications for Physically Abusive Families Mark Chaffin, Ph.D Beverly Funderburk, Ph.D. Jane Silovsky, Ph.D. University of Oklahoma Health Sciences Center Department of Pediatrics

copyright CCAN 2005 Alternatives for Families I and II Research supported by: Research supported by: –Office of Child Abuse and Neglect Administration on Children, Youth and Families –Oklahoma Department of Human Services –Parents Assistance Center, OKC Acknowledge contributions of: Acknowledge contributions of: –Linda Ann Valle, PhD, CDC –Elizabeth Brestan, PhD, Auburn University –Tatiana Balachova, PhD, OUHSC –Shelli Shultz, PhD –Many interns, practicum students

Alternatives for Families III Research supported by: Research supported by: –Centers for Disease Control and Prevention National Center for Injury Prevention and Control Division of Violence Prevention –Oklahoma Department of Human Services –Parents Assistance Center, OKC Acknowledge contributions of: Acknowledge contributions of: –Linda Valle, Ph.D. Allison Garrett, M.Ed. –Jane Silovsky, PhD Rebecca Hurst, M.S. –Carol McCoy, M.Ed. –Desi Vasquez, M.S. –Carol Moore, M.S.

copyright CCAN 2005 Alternatives for Families III Parents Assistance Center Therapists: – Barbara Culbertson – Gayla Westbrook – Elizabeth Altshuler – Amanda Wiens – Rebecca Thompson

copyright CCAN 2005 AFF-I Inclusion Criteria –Confirmed physical abuse –Child age 4 to 12 –Parent IQ > 70 –No evidence of child sexual abuse

copyright CCAN 2005 PCIT Adapted Modifications to PCIT: 6 session ME orientation group 6 session ME orientation group 14 PCIT sessions rather than criterion based 14 PCIT sessions rather than criterion based Developmentally appropriate approaches for children ages 8 to 12 years Developmentally appropriate approaches for children ages 8 to 12 years Special issues related to physically abusive families Special issues related to physically abusive families

copyright CCAN 2005 PCIT: Motivation Group Reasons for Motivation Group Reasons for Motivation Group –PCIT requires considerable parent activity and can not be passively consumed –Parents may be coerced into treatment and be unmotivated to change behavior Group based on Stages-of-Change Theory and Motivational Interviewing Group based on Stages-of-Change Theory and Motivational Interviewing

copyright CCAN 2005 Adaptations for Physical Abuse Trauma Focus in CDI: Trauma Focus in CDI: –Acknowledge child’s feelings –Reassure child of security –Contain the emotions (Return to PRIDE skills)

copyright CCAN 2005 Adaptations for Physical Abuse PDI Modifications: PDI Modifications: - Include stress monitoring - 30 minute time limit - Menu of timeout backup options - Range of PDI coaching options (e.g, siblings, homework, role play)

Design Referrals from Child Welfare ME + PCIT Follow-up Assessment Data Collection Pre- testing Post- testing Follow-up CPS reports Recruitment & Randomization Refusers ME + PCIT + Wrap-Around Standard Community Orientation + Parent Training Groups 6 months Treatment Dropouts Study Design: AFF-I

copyright CCAN 2005 Physical Abuse Outcome Project: Participants 111 participants 111 participants –66% female –White = 50% African Am = 39% Am Indian= 5% Hispanic = 5% –Mean Child Age = 7.9 –Mean Physical Abuse Reports = 2.0 Mean Past Neglect Reports = 2.1 –Mean CAPI = 172 (cut-off = 166). –Modal income range $7,200 - $15,000 annually

copyright CCAN 2005 Percent Re-Report of Abuse in Groups after 850 Days Results of first study published in Journal of Consulting and Clinical Psychology, 2004

Parent Negative Behaviors (Criticism, Sarcasm, Negative Touch) 30-min DPICS observation

copyright CCAN 2005 Questions Remaining Relative contributions of ME and PCIT for reducing future reports of physical abuse Relative contributions of ME and PCIT for reducing future reports of physical abuse – ME group alone sufficient for gains? – ME group reduce dropout in parenting program? University lab vs. community agency University lab vs. community agency Cost-effectiveness in field setting Cost-effectiveness in field setting

copyright CCAN 2005 AFF-III Inclusion Criteria –“Parenting” on DHS treatment plan –Child aged 2.5 to 12 –Parent IQ > 70 –No evidence of child sexual abuse by participating caregiver

AFF-III Design: all services provided in community agency Follow for CPS Reports Follow for CPS Reports Standard Standard Orientation R PCIT Orientation R PCIT Group Group Volunteers Baseline R Mid Post ME Parenting and ME Parenting and Orientation R Anger Groups Orientation R Anger Groups Group Group

copyright CCAN 2005 Hypotheses ME group participants will show higher completion rates and better outcome in parenting programs than standard orientation group participants ME group participants will show higher completion rates and better outcome in parenting programs than standard orientation group participants Higher completion rates in parenting programs will be moderated by the quality of the parenting intervention, favoring PCIT Higher completion rates in parenting programs will be moderated by the quality of the parenting intervention, favoring PCIT Improved retention will improve cost effectiveness of the relatively more expensive PCIT Improved retention will improve cost effectiveness of the relatively more expensive PCIT

copyright CCAN 2005 AFF-III: Issues with Community Implementation Children Placed Out of Home Children Placed Out of Home – AFF-I: 20 % had child removed at intake (32% ever) –AFF-III: 57% of target children out of home at intake

copyright CCAN 2005 PCIT with Out of Home Placements Transportation To and From Sessions Transportation To and From Sessions – Case management issues – Need for agency transportation PCIT Homework – Practice with other children? – Drills/Role Play homework? – Will skills generalize?

copyright CCAN 2005 PCIT with Out of Home Placements Transportation Transportation – case management issues – need for agency transportation Homework Homework – other children available? – drills/role play In-session Issues In-session Issues – sessions as visits

copyright CCAN 2005 PCIT with Out of Home Placements Tracking status and progress – very messy data Tracking status and progress – very messy data - track how much contact/practice - track access/practice with other children - changes in contact during treatment PCIT

copyright CCAN 2005 Predicting Long-term Outcome Meeting CDI/PDI criteria predicts maintenance of treatment gains in ODD children Meeting CDI/PDI criteria predicts maintenance of treatment gains in ODD children We are trying to maintain reduced rates of physical abuse... We are trying to maintain reduced rates of physical abuse...

copyright CCAN 2005 PCIT Skills Acquisition Preliminary Findings on Skills Acquisition Preliminary Findings on Skills Acquisition – CDI: 30% (n = 44) – PDI: 63% (n = 27) So, how good do their skills need to get? How long should we try? So, how good do their skills need to get? How long should we try?

copyright CCAN 2005 Ongoing Community PCIT Services Need to plan for post-grant continuation of PCIT services in agency Need to plan for post-grant continuation of PCIT services in agency – Payment/contract issues – Agency/board support – Support from contracting agencies – Ongoing consultation