1. The 3 Faces of DPICS: Examining coding protocols for research & practice Susan Timmer, PhD., Nancy Zebell, PhD. Anthony Urquiza, PhD CAARE Diagnostic and Treatment Center Department of Pediatrics UC Davis Children’s Hospital Sacramento, CA 916 734-6610 www.pcittrainingcenter.org Copyright 2004. UC Regents. All rights reserved.

2. Acknowledgments Michelle Culver Ryan Fussell Dianne Thompson Lindsay Klisanac Erica Goude Alan Chan Natalie Lambdin David Benjamin Grace Silvia

3. Objectives Explore different ways of using DPICS to assess treatment progress at mid-treatment. Discuss the usefulness of conducting a mid-treatment DPICS assessment.

4. Reviewing the Goals of CDI General Treatment Goal: – Help parent develop warm, sensitive parenting style while still able to set limits in a non-coercive way (Baumrind, 1966). Goal of PCIT therapist: – Adjust specific patterns of parents’ verbal behavior, thereby adjusting parents’ and children’s expectations of one another, and the quality of their relationships.

5. PCIT Model of Change Model : Proximal: primary goalSecondary Goal Change parent verbal Change of quality responses to child behaviorof parenting Change child’s behavior

6. Mid-treatment DPICS Assessment: Current practices at UCD CAARE Parents must meet mastery criteria twice during the 5-minute coding in CDI sessions. Decision to move dyad to PDI is based on CDI performance, not mid- treatment assessment. 15 Minute DPICS videotaped Only CDI segment of DPICS is coded (live) to check parents’ continued use of PRIDE skills. A 5-minute coding is done throughout treatment using CDI instructions. Agencies trained by UCD CAARE are told that Mid- Treatment DPICS is optional.

7. Goals & Purposes of a Assessment at Mid-Treatment Goals: – Measure the degree to which therapists’ have changed parents’ verbal behavior – Measure the degree to which the changes in verbal behavior have changed the quality of the parent-child relationship. Purposes: – Better understanding of parents’ generalization of CDI skills to different situations. – Better understanding of child’s response to parent’s use of power and control in context of their new CDI skills. – Greater sensitivity to dyads’ strengths and weaknesses.

8. Method & Procedure CODING OF 15-MINUTE DPICS ASSESSMENT MID- TREATMENT – DPICS II coding of mother & child verbalizations – 5-minute CDI – 2 minutes each of CDI, PDI, and Clean Up – Emotional Availability (CDI, PDI, & CU) using EA Scales, 3 rd Ed. (Biringen, 1998). Parent scales quantify sensitivity, hostility, intrusiveness, & structuring. Child scales quantify responsiveness to parent & involvement of parent in play. – Why the first 2 minutes of CDI, PDI & CU? (Maximizes times of transition) – Why use EA scales? (Need to measure the global quality of the parent-child relationship)

9. Sample Description 25 Biological Mother-Child dyads: Children - Sex : 80% male (20 boys) Mean age: 4.00 yrs (Range, 2 – 6 yrs) Ethnicity:80% Caucasian Physically abused: 49% Mothers- Mean age: 28.9 yrs (Range, 22 – 42 yrs.) Education:64% HS grad or less, mean 12.6 yrs. Marital status: 32% married, 40% divorced/separated, 28% single Perpetrators of abuse: 20% Victims of domestic violence: 24%

10. Question 1: Is 2 minutes of coding a representative sample of a 5 minute segment of CDI at Mid-treatment? Question 2: What does 2 CDI-2 PDI-2 CU coding indicate that 5 minutes of CDI does not? Table 1: % of Verbalizations in 5 minutes of CDI, 2 minutes of CDI, and 2 minutes of CDI, PDI, and CU combined (6 minutes total) 5 min CDI 2 min CDI2 CDI -2 PDI -2 CU % of parent total BD %7.4%5.5%* 3.7 *** ID35.734.2 ns 36.4 ns UP10.210.1 ns 9.3 ns LP10.6 9.1 ns 6.7 ** RF 8.210.4 * 5.7 *** Q 5.9 6.6 ns 6.6 ns DC + IC 7.5 8.3 ns 20.4 *** CR 0.8 0.8 ns 1.3 ns Child CR 4.9 4.8 ns 16.7 **

11. Summary of analyses of DPICS II coding 5 min vs 2 min CDI comparisons revealed few differences. Only fewer BDs and more RFs are observed. Other percentages of parent verbalizations did not differ significantly. – Conclusion: Coding for 2 minutes may be sufficient to obtain a representative sample of parent-child interactions. 5 minutes of CDI vs. the first 2 minutes of CDI, PDI, and CU show significantly more commands, and fewer BDs, RFs, and LPs. A significant increase in child critical statements were also observed. – Conclusion: Greater total numbers of parent commands and child critical statements suggest that CDI skills might not be generally maintained across PDI and Clean-Up.

12. Using EA to detect differences in parenting quality Table 2: Mean scores parent EA scales in CDI, PDI, and CU CDI PDI CU ( Range/ Opt.) Parent Scales Sensitivity 6.7 5.6 5.4(1-9/ 6+) Hostility 4.9 4.6 4.4(1-5/ 5) Intrusiveness 4.0 3.8 3.7 (1-5/ 4+) Structuring 4.3 3.4 3.6 (1-5/ 4+) Child Scales Responsiveness5.2 4.1 4.0(1-7/ 5+) Involvement5.3 4.4 4.0(1-7/ 5+)

13. Using EA to detect differences in parenting quality Table 3: Number of mothers with no, 1-2, or 3-4 parent EA scales in non-optimal range (sensitivity, hostility, intrusiveness, structuring) in CDI, PDI, and CU. # Non- optimalCDIPDICU None13 5 5 1 – 2 910 7 3 – 4 31013 Cluster analysis using numbers of non-optimal scales in CDI, PDI, & CU revealed 3 groups with different patterns of parenting quality in the DPICS assessment: – Optimal parenting CDI, PDI, CU (N=9) – Mixed: Optimal parenting CDI, non-optimal PDI & CU (N=10) – Non-optimal parenting CDI, PDI, CU (N=6)

14. Question 3: How can we tell these groups apart by looking at parents’ DPICS verbalization patterns? Table 4: Number of positive verbalizations (BD, RF, LP, & UP) in CDI, PDI, & Clean Up for Optimal, Mixed, and Non-optimal groups DPICS- # Positive verbalizations CDI PDICU Optimal 38.4 16.829.3 Mixed 39.5 10.913.3 Non-optimal 23.2 15.123.6

15. Figure 1: Number of positive verbalizations (BD, RF, LP, & UP) in CDI, PDI, & Clean Up for Optimal, Mixed, and Non-optimal groups

16. Parenting quality group differences (cont’d.) Table 5: Mean number of negative verbalizations (IC, DC, & CR) in CDI, PDI, & Clean Up for Optimal, Mixed, and Non-optimal groups # Negative CDI # PDI# CU# Optimal 2.75.7 9.1 Mixed 1.66.3 13.2 Non-optimal 5.57.5 7.2

17. Figure 2: Mean number of negative (IC, DC, & CR) verbalizations in CDI, PDI, & Clean Up for Optimal, Mixed, and Non-optimal groups

18. Question 4: Can we discriminate between types of parents by assessing children’s behavior during the 15 minute DPICS? Child Responsiveness (Range = 1 – 7; Optimal range= 5 - 7) Willing to go along with parent’s ideas Engages easily with parent, does not ignore parent’s bids to play Happy Relaxed Willing to let parent be in charge, doesn’t give parent a lot of commands Balance between focus on autonomous play and parent’s engagement No negative affect apart from possible initial protest to activity change

19. Figure 3: Children’s responsiveness (EA) to parents by parenting quality in DPICS (Optimal range= 5+)

20. Reflections of the parenting quality: Assessing child’s behavior from looking at the 15 minute DPICS (cont’d.) Clean up performance: – Compliant- cleans up when asked, does not have to be asked repeatedly to clean up, may protest mildly when initially asked to clean-up – Compliance with considerable prompting- Cleans up, but gets easily side-tracked and is repeatedly prompted, or tries to distract parent from need to clean up. – Mostly to completely non-compliant- Does not comply with most requests. May put a few things away, or put toys away then refuse to come back to chair, but predominantly non-compliant.

21. Figure 4: % of children who clean up when parents are in optimal, mixed, and non-optimal parenting quality groups

22. Clinical Implications Goals of assessment – Better understanding of parents’ generalization of CDI skills to different situations. – Better understanding of child’s response to parent’s use of power and control in context of their new CDI skills. – Greater sensitivity to dyads’ strengths and weaknesses. Implications for quality of treatment provision

23. Questions? Comments Thank You!