Transcript Parent Consultation - University of Nebraska–Lincoln

Parent Child
Interaction Therapy
(PCIT)
The Future of School Psychology Task
Force on Family-School Partnerships
Kathryn Woods, Stephanie Bieltz, and Amanda
Clinton
Definition
PCIT is a short-term, empirically
validated intervention that is designed
for families with young children.
This form of treatment may be used for
externalizing and internalizing problems
and a broad range of behavioral, emotional, and
developmental problems exhibited in childhood.
See PCIT Handout 1 for More Information
Rationale for a Multi-Tiered Approach to
Family-School Partnerships
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Family-school partnerships provide a context for
families and educators to collaboratively identify and
prioritize concerns across a continuum of
opportunities and intensities
Prevention and intervention efforts and supports are
delivered toward a universal and targeted audience
A multi-tiered approach enables families and educators
to provide services based on a student’s responsiveness
to previous preventions, interventions, and supports
See PCIT Handout 2 for More Information
Explanation for a Multi-Tiered Approach
to Family-School Partnerships
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Provides various levels of family-school supports based
on a student’s identified need and responsiveness to
previous efforts
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Universal – Family-school collaboration provided to support all students
and families (e.g., 4 As, Parent-School Collaboration, Parent Involvement,
Parent Education)
Targeted – Family-school collaboration provided to support identified
students and families unresponsive to previous universal efforts (e.g.,
Parent Education and Intervention, Parent Consultation)
Intensive – Family-school collaboration provided to students and families
unresponsive to previous targeted efforts (e.g., Parent Consultation
[conjoint behavioral consultation] and Parent Intervention)
The Multi-Tiered Approach to
Family-School Partnerships
Tier 3: Intensive, Individual Interventions
Individualized supports for families and students unresponsive to the
first two tiers (e.g., Parent Consultation [conjoint behavioral
consultation] and Family Intervention)
Tier 2: Targeted Group Interventions
Tier 3
1-7%
Specific preventions and remedial interventions for
targeted groups of families and students identified as “at
risk” and unresponsive to the first tier (e.g., Parent
Training and Intervention, Parent Consultation)
Tier 2
5-15%
Tier 1: Universal Interventions
Tier 1
80-90%
Engaging all families as collaborative
partners (e.g., 4 As, Family-School
Collaboration, Parent Involvement,
Parent Education)
Rationale for Using PCIT
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Early intervention is critical to prevent negative developmental trajectories and
outcomes
Unlike other techniques used to improve child behavior, PCIT emphasizes a
comprehensive treatment approach that is focused on increasing positive
behavior, decreasing negative behavior, and improving the parent-child
relationship (McDiarmid & Bagner, 2005)
Parent-child relationships are at the heart of many intervention efforts and
intervention efforts that focus on improving this relationship enable families
to interact with their children and achieve satisfying relationships and positive
outcomes for children and their families for years to come (Epps & Jackson,
2000)
See Overview Module for More Information on
Partnering with Families
PCIT Research
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Research examining the effectiveness of PCIT has
found:
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Statistically and clinically significant improvements in child
disruptive behaviors and noncompliance
Treatment effects that generalize to home, daycare, preschool,
early elementary classroom settings, and untreated siblings
Significant improvements in parent reported activity and
stress levels, child internalizing problems, and self-esteem
High degree of participant satisfaction
Clinically significant improvements maintained at one and
two-year follow-up evaluations
See PCIT Implementation Guidelines for Factors that
Influence the Effectiveness of PCIT
Treatment Goals
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Goals for treatment include:
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An improvement in the quality of the parent-child
relationship
An increase in parenting skills
An increase in child prosocial behaviors
A decrease in child behavior problems
A decrease in parenting stress
(Hembree-Kigin & McNeil, 1995)
Steps in PCIT
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Step 1: Pretreatment Assessment of Child
and Family Functioning and
Feedback
Step 2: Teaching Behavioral Play Therapy
Skills
Step 3: Coaching Behavioral Play Therapy
Skills
Step 4: Teaching Discipline Skills
Steps in PCIT cont.
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Step 5: Coaching Discipline Skills
Step 6: Posttreatment Assessment of
Child and Family Functioning and
Feedback
Step 7: Boosters
(Information on steps and session content gathered from Hembree-Kigin & McNeil, 1995)
Session #1 - Intake
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Average Length: 1-2 Sessions
Process:
 Information is gathered on concerns, developmental
history, family functioning, and family stressors
 Formal testing is conducted which will serve as a
baseline measure of a child’s behavior and parenting
skills
 Therapist observes and may videotape how the parent
and child interact with one another
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Feedback on these interactions will be provided during the next
session
See PCIT Implementation Guidelines for
More Information on PCIT Sessions
Session #1 – Intake
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Process cont.:
 Information is also collected regarding the family’s experience using
time-out
 Time-out is described in later sessions so it is important to
inform the family that the time-out that will be described is
different from the one that may have been used unsuccessfully
in the past
 Feedback regarding assessment results and treatment planning is
provided
 Preliminary feedback on observations is discussed along with
results from formal testing
 Parents are asked why they believe their child is experiencing
problems
 Therapist tries to reduce any feelings of guilt the parents
may have for their child’s behavior problems while also
encouraging them to take responsibility for successfully
resolving them
Available Resources
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Assessment tools that may be used during intake:
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Parent Report Measures:
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Child Behavior Checklist – Parent Form
Eyberg Child Behavior Inventory
Parenting Stress Index
Social Skills Rating System
Conners Parent Rating Scale – Revised
Vineland Adaptive Behavior Scales
Childhood Autism Rating Scale
Minnesota Multiphasic Personality Inventory – 2
Beck Depression Inventory
See PCIT Handout 3 for References
Available Resources cont.
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Assessment tools that may be used during intake:
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Teacher Report Measures:
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Sutter-Eyberg Student Behavior Inventory
Child Behavior Checklist
Social Skills Rating System
Conners Teacher Rating Scale
Child Report Measures:
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Harter Pictoral Scale of Perceived Competence and Social
Acceptance for Young Children
Peabody Picture Vocabulary Test – Revised
See PCIT Handout 3 for References
Session #2 –
Teaching Behavioral
Play Therapy
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Average Length: 1 Session
Process:
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Goals of behavioral play therapy are described
Rationale for the use of brief daily home “play therapy”
sessions is presented
“Do” and “Don’t” skills of behavioral play therapy are
described
Use of strategic attention and selective ignoring are discussed
All skills are modeled together
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Parents are coached as they role-play skills
Logistics of play therapy at home are discussed
Session #2 –
Teaching Behavioral
Play Therapy
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Goals of Behavioral Play Therapy
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Goals based on presenting concerns
Important to convey that playtime is a therapeutic
intervention and not “just playing” with the child
Daily Home Play Therapy Practice
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To be done for at least 5 minutes everyday with the child
leading the activity
Play therapy should not be viewed as a privilege that the child
can earn or lose
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Playtime is often more important on days when the child has
misbehaved
Session #2 –
Teaching Behavioral
Play Therapy
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“Do” Skills (DRIP)
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Describe appropriate behavior
Reflect appropriate verbalizations
Imitate appropriate play
Praise prosocial behavior
“Don’t” Skills
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Give commands or make requests
Ask questions
Criticize or correct in a negative way
Session #2 –
Teaching Behavioral
Play Therapy
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Using Strategic Attention
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Involves using the “Do” skills of behavioral play therapy
Used to reward the behaviors adults would like to see the child display
more often
First, identify the behaviors or qualities that the parent sees as desirable
and prosocial even if infrequent at first
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Once behaviors are identified, parents are to lookout for targeted
behavior
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Parents may want to think of the behaviors they would like to see their child
display as opposed to their inappropriate behaviors
“Catch the child being good”
Parents are encouraged to use strategic attention and praise appropriate
behavior as much as possible throughout the day
Session #2 –
Teaching Behavioral
Play Therapy
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Using Selective Ignoring
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Parents are to identify behaviors or qualities they would like to see
diminished
In order for ignoring to be effective the child must be doing the
problem behavior to get a reaction or attention from the parent
Therapist then helps the parents analyze whether or not their
attention rewards the child for engaging in each of the behaviors
and whether the removal of attention should be expected to impact
the behavior
Important for parents to understand that a behavior that is ignored
will get worse before it gets better
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Parents should determine if they can tolerate having the behavior get
worse before it gets better
Parents must also understand that once they begin to ignore a behavior
they must continue to ignore the behavior until it stops occurring
Session #2 –
Teaching Behavioral
Play Therapy
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Modeling Skills Together
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The therapist may model the skills with the parent pretending
to be the child or show a videotaped segment of a parent
with a child who presented with similar problems
After demonstrating the combined skills the parent performs
a role-play
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The therapist should encourage parents to perform the “Do” skills
and may suggest specific phrases for the parent to repeat
Purpose is to show the parent how it feels to do the skills and
what it is like to have someone providing frequent feedback
on their performance
Session #2 –
Teaching Behavioral
Play Therapy
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Considerations:
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Behavioral play therapy is particularly helpful for one-parent families
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Two-parent families should consider alternating days in which each
parent engages in play therapy with the child
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Parents can also do play therapy at home with all of their children
between the age of 2 and 7
Before leaving the session, parents should know when and where
they will conduct play therapy in their home
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These parents may often feel stressed and overburdened and this
playtime provides them with positive interactions and time with their
children
Should be done in a place that is quiet, private, and free of distractions
and should occur at about the same time everyday
Parents are reminded to practice for 5 minutes a day and are given a
recording sheet to note whether or not they practiced and any
difficulties or problems that came up during playtime
Session #3 –
Coaching Behavioral
Play Therapy Skills
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Average Length: 2 – 4 Sessions
Process:
Check-in and review homework
 Recording of play therapy skills
 Coaching of play therapy skills
 Feedback on progress and homework
assignment
 Individual time with child (optional)
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Session #3 –
Coaching Behavioral
Play Therapy Skills
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Observing Behavioral Play Therapy Skills
The parent and child play together for five minutes
and the therapist records the parent’s progress on a
chart that is updated on a weekly basis
 Progress is compared to mastery criteria
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Criteria is based on concept of overlearning principles
taught by therapists
Session #3 –
Coaching Behavioral
Play Therapy Skills
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Coaching the “Do” and “Don’t” Skills: Tips for
Therapists
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Make coaching brief and precise
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Should take the form of labeled praise, gentle correction, directives,
and observations
Coach after nearly every parent verbalization
Give more praise than correction
Coach easier skills first
Incorporate observations into feedback
Make use of humor
Move from more directive to less directive coaching
Session #3 –
Coaching Behavioral
Play Therapy Skills
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Qualitative Aspects of Parent-Child Interactions
Physical closeness and touching
 Eye contact, facial expressions, vocal qualities
 Turn-taking, sharing, polite manners
 Developmentally sensitive teaching
 Task persistence
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Session #4 –
Teaching Discipline Skills
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Average Length: 1 Session
Process:
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Explain use of compliance exercises
Discuss how to give effective directions
Discuss how to determine if child has obeyed
Discuss consequences for obeying
Discuss consequences for disobeying
Present backups for time-out
Coach parents as they role-play discipline skills
Session #4 –
Teaching Discipline Skills
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Importance of Compliance Exercises
Parents are informed of the importance of
consistency, predictability, and follow-through
 Parents are taught to view all misbehavior as falling
into two categories: noncompliance and
disruptiveness
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Noncompliance – refusing to do what one is told
 Disruptiveness – doing things that one is told not to do
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Session #4 –
Teaching Discipline Skills
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Importance of Compliance Exercises cont.
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Best way to teach compliance is through practice
By receiving a great deal of enthusiastic praise for small
accomplishments, the child views minding in a more
positive light and the habit of defying simple requests is
weakened
Once compliance is improved within these exercises
parents are coached in more real-life situations such as
getting their child to come in from outside
Session #4 –
Teaching Discipline Skills
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Determining Compliance:
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Even with well-stated commands it is sometimes difficult to
determine if a child has obeyed
The following situations should be discussed with the parent
to determine if the child complied with the parent’s direction
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Doing something slightly different from the parent’s request
Dawdling
“Playing Deaf ”
Partially complying
Minding with a bad attitude
Undoing
Session #4 –
Teaching Discipline Skills
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Consequences for Obeying
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Parents are taught to praise their child as specifically as
possible when their child complies with a request
Labeled praise such as: “Thanks for minding,” “I like it when
you do what I ask,” or “Good following instructions!”
When enthusiastic labeled praises are given for listening
children begin to view compliance in a more positive light
In addition to labeled praise, the parent should mention that
they are happy that the child did not have to go to time-out
Session #4 –
Teaching Discipline Skills
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Consequences for Disobeying
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If a child does not follow a parent’s command, parents are
instructed to not repeat the command, but make a “two-choices
statement”
Parents hold up two fingers and says in a neutral tone of voice,
“You have two choices. You can put Mr. Potato Head back in the
box or go to time-out.”
It is critical that a parent never provides a two-choices statement
without being prepared to follow through with time-out
After giving the statement, parents are taught to watch closely to
determine whether their child has complied
 If so, enthusiastic praise is given
 If not, the parent should proceed with time-out
Session #4 –
Teaching Discipline Skills
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Time-Out
Parent should escort child to time-out and then
explain that the child is to sit in the chair until
they can get off
 The time-out chair should be in a specific,
“boring” location that is free from distractions
or attention from others
 Time-out is over after the child has spent three
minutes in time-out chair
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More time may be added if child misbehaves in timeout chair
Session #4 –
Teaching Discipline Skills
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Backups for time-out
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Ways to handle time-out escape
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Isolation in another room
Restriction of privileges
Stand by time-out chair
Place hand on child’s shoulder as they sit in time-out
Repeatedly place child back in time-out chair
Add additional time for time-out escapes
Explain to child that time-out does not begin until they sit
appropriately
Parents role-play discipline skills
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Time-out procedures are reviewed
Parents should not use time-out until after the next session with
additional coaching by the therapist
Session #5 –
Coaching Discipline Skills
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Average Length: 4-6 Sessions
Process:
Rehearse time-out with family
 Coach discipline skills
 Combine play therapy and discipline skills
 Coach time-out
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Session #5 –
Coaching Discipline Skills
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Guidelines for Coaching Discipline Skills
Give one instruction at a time
 Use positively stated instructions
 Coach both verbal and nonverbal communication
 Praise parental compliance
 Offer support and reassurance
 Use relaxation training strategies
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Session #6 –
Posttreatment Assessment of
Child and Family
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Average Length: 1 – 2 Sessions
Process:
Therapist and family review therapy progress
 Discuss strategies for addressing any remaining
problems
 Decide on a schedule for maintenance or
“booster” sessions
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Session #6 –
Posttreatment Assessment of
Child and Family
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Measures that were administered before treatment are repeated
 Changes on formal measures and videotaped interactions of
the family from pretreatment to posttreatment are reviewed
Problem-solving skills are reviewed with the parents so that they
can apply their new parenting strategies to a variety of problems
that may come up
 Parents are asked to identify at least one remaining concern
and formulate a plan to address this concern
CASE EXAMPLE
Background
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Tommy is a 5-year, 3 month-old English-speaking
African-American male who demonstrates behavioral
difficulties including talking back to adults, ignoring
directions, and hitting other children when frustrated
He is the child of an older single mother and has two
siblings in their early twenties
Step 1 –
Pretreatment Assessment
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Interview:
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Mrs. Smith, Tommy, and Tommy’s siblings attend the session
First, the limits of confidentiality are explained to the family
During a semi-structured interview, Mrs. Smith describes
Tommy’s developmental history, which is significant for slight
language delays. She shares that the family is under
considerable stress given her long work days, the absence of
Tommy’s father, and the need to rely on her adult children to
care for Tommy after preschool
Step 1 –
Pretreatment Assessment, cont.
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Interview, cont.:
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During the interview, Tommy is permitted to play with toys in
the room. He is observed by the therapist to select plastic
dinosaurs which he has ‘run’ in the air and often strikes
against one another with loud crashing sounds
As Tommy becomes increasingly louder and more active,
Mrs. Smith responds to his behavior by yelling, “Stop!”
Similar techniques are employed by Tommy’s elder sister,
while his brother ignores Tommy
The therapist is careful to encourage Mrs. Smith to feel
comfortable managing her son’s behavior as best she can and
does not intervene
Step 2 – Formal Assessment
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Formal Assessment:
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Tommy is observed for a few minutes while the therapist
speaks to his mother about the questionnaires she will
complete
Next, formal assessment is conducted
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Tommy is administered the Peabody Picture Vocabulary Test due to
reported concerns about his language development
While Tommy is being evaluated, Mrs. Smith responds to the items
on a series of behavioral checklists, including the Child Behavior
Checklist – Parent Form, Eyberg Child Behavior Inventory, and
Parenting Stress Index, in order to establish baseline information
Step 2 –
Teaching Behavioral
Play Therapy
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Teaching Play Therapy:
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Mrs. Smith receives information about the goals of play therapy
Mrs. Smith learns that the interventions are designed to improve her
relationship with her son while reducing Tommy’s aggression and anger
and increasing his self-esteem
Daily home therapy is explained to her as being done for at least 5
minutes each day and that the child should lead the activity
She expresses understanding, along with doubts, that this 5 minute play
activity must take place even on days when Tommy has been noncompliant because it can break the negative cycle of behavioral noncompliance
Step 2 –
Teaching Behavioral
Play Therapy, cont.
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Teaching Play Therapy, cont.:
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The therapist explains the acronym “DRIP” to Mrs. Smith.
Mrs. Smith practices with the therapist, starting out by saying,
“You play with the dolls.” The therapist reminds her it is
important to describe, reflect, imitate, and praise. Mrs. Smith
then says, as the therapist picks up a car and starts to play
with it, “You picked a red car and you are driving it along the
street.”
Step 2 –
Teaching Behavioral
Play Therapy, cont.
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Teaching Play Therapy, cont.:
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When Mrs. Smith demonstrates a solid grasp of the use of
“DRIP” techniques through role plays with the therapist, she
and the therapist make plans for follow-up play sessions at
home
Mrs. Smith decides that the most convenient place and time
to practice behavioral play therapy will be just after dinner
each day. She plans to play with Tommy in his room, since it
is a relatively quiet location
Step 3 –
Coaching Behavioral
Play Therapy
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Coaching Play Therapy:
Mrs. Smith shares her record of play therapy
sessions
 She demonstrates that she engaged in play therapy 5
of the 7 days between sessions
 Her efforts and consistency are praised by the
therapist
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Step 3 –
Coaching Behavioral
Play Therapy
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Coaching Play Therapy, cont.:
Next, Mrs. Smith and Tommy play together for 5
minutes in a therapy room while the therapist
observes behind a one-way mirror
 Mrs. Smith is reminded to praise Tommy when he
shares his toy with her and to avoid asking questions
and giving commands
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Step 3 –
Coaching Behavioral
Play Therapy, cont.
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Coaching Play Therapy, cont.:
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Mrs. Smith shares her record of play therapy sessions indicating that she
engaged in play therapy 6 of the 7 days between sessions
During this 2nd session, focused on coaching behavioral play therapy, Mrs.
Smith is encouraged to ignore behaviors that continue to be of concern
to her. Specifically, when Tommy grabs toys away from her or bangs them
together, she attends to another toy and does not say anything
As soon as Tommy realizes that his mother is not attending to his acting
out, he offers to share with her. Mrs. Smith reflects on this behavior and
praises him
Step 3 –
Coaching Behavioral
Play Therapy, cont.
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Coaching Play Therapy, cont.:
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Mrs. Smith shares that she engaged in play therapy 4 of the 7 days
between sessions
During this session, qualitative aspects of PCIT are the focus
Mrs. Smith is encouraged to make eye contact with Tommy and sit close
to him or give him a hug when he engages in appropriate behaviors,
especially when he persists on a task that is difficult for him
Tommy responded to attention from his mother by continuing to engage
in appropriate behaviors
Step 4 –
Teaching Discipline Skills
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Teaching Discipline:
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This session explains to Mrs. Smith how to effectively
implement consequences for Tommy’s inappropriate
behavior
The therapist focuses on increasing Tommy’s compliance
during play by helping Mrs. Smith give effective directions to
Tommy
When they are not followed, Mrs. Smith identifies and
responds to non-compliant behavior
Step 4 –
Teaching Discipline Skills
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Teaching Discipline, cont.:
Mrs. Smith gives Tommy two choices, to follow her
command or go to time-out
 Mrs. Smith practices giving direct commands and the
use of time-out in the therapist’s office
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Step 5 –
Coaching Discipline Skills
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Coaching Discipline:
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Mrs. Smith is taught to increase Tommy’s compliance with
her requests by setting small goals toward a skill that she
knows Tommy can learn
Mrs. Smith picks building a house with blocks, since she
knows Tommy can do it. She begins by giving Tommy a
single simple instruction, “Tommy, put the red blocks at the
bottom of the house”
When he does so, she smiles broadly, gives him a pat on the
back and says, “Good listening! You put the red blocks at the
bottom of the house”
Step 5 –
Coaching Discipline Skills
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Coaching Discipline, cont.:
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Mrs. Smith continues to give commands in simple language
When Tommy is noncompliant, Mrs. Smith holds up two
fingers and calmly but firmly says, “Tommy, you have two
choices. You can put the roof on the house or go to timeout”
Tommy stands with his arms folded looking at his mother
then throws a block
Mrs. Smith gets up and escorts Tommy to time-out. He will
not go with her so she gently picks him up and sets him in
the pre-determined time-out area for 3 minutes
Step 5 –
Coaching Discipline Skills
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Coaching Discipline, cont.:
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When time-out is over, Mrs. Smith repeats the original
command in which Tommy was noncompliant
Mrs. Smith says, “Tommy, put the cardboard on top for a
roof.” Tommy does nothing
Mrs. Smith holds up two fingers and says, “Tommy, you have
two choices. You can put the chimney on the roof on the
house or go to time-out.”
Tommy hesitates, and then puts the chimney on the roof of
the house, which causes it to collapse
Mrs. Smith praises Tommy for showing he was listening by
putting chimney on the house
Step 5 –
Coaching Discipline Skills
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Coaching Discipline, cont.:
Mrs. Smith and Tommy play in an appropriate
manner without further events during this session
 Tommy obeys commands that his mother makes in
an appropriate fashion and time-out is not required
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Step 6 – Posttreatment Assessment
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Posttreatment Assessment:
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The measures utilized in the initial assessment are re-administered in
order to provide comparative results to Mrs. Smith
Results indicate that Tommy demonstrates significantly less aggression
during play and more appropriate methods for seeking his mother’s
attention. Areas of progress are discussed and comparison scenes on
videotape are shown to demonstrate Tommy’s improvements
Tommy’s remaining difficulties of a short attention span and limited
coping skills for challenges are discussed
Mrs. Smith indicates a willingness to continue to work on gradually
increasing Tommy’s play sessions to help with his attention span. She also
discusses ways in which she can provide additional praise that might
influence greater coping during play therapy sessions at home
Step 6 – Posttreatment Assessment

Posttreatment Assessment, cont.:
 Maintenance sessions are scheduled once a month with Mrs.
Smith and Tommy
 At each session, the therapist and Mrs. Smith discuss present
concerns and ways to address them
 Mrs. Smith and Tommy spend time interacting with one
another while the therapist provides feedback and
reinforcement as needed
 A future booster session is scheduled for 3 months after their
last meeting
Future Directions
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Determine what specific context or individual variables lead to
greater treatment effectiveness
Identify groups most likely to benefit from treatment to ensure
that services are provided to those who will most likely benefit
Identify groups who have shown to be less responsive to
treatment to identify groups in need of further study and how to
modify PCIT procedures to better serve these groups
Examine effects in real-world clinics without intense supervision
to improve treatment protocols and dissemination
Examine outcomes for families that do not complete training
(Herschell, Calzada, Eyberg, McNeil, 2002)
Future Directions
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Examine the range of comorbid disorders (e.g. internalizing
disorders, chronic pediatric illness, developmental disorders) that
may be affected by PCIT
Explore the extent to which PCIT can be adapted
Investigate effectiveness of PCIT among diverse populations in
terms of ethnicity and cultural factors
Determine ways in which treatment should be tailored to
maximize gains in minority groups
Examine what therapist behaviors contribute to improved
treatment outcomes
(Herschell, Calzada, Eyberg, McNeil, 2002)
Future Directions





Identify families at-risk for drop out and factors that may
promote their adherence to treatment
Determine the level of training necessary to produce therapeutic
gains
Evaluate alternate ways to deliver treatment to ensure accurate
implementation so critical treatment components are not altered
Examine long-term maintenance of treatment effects
Predictors of long-term treatment outcomes
(Herschell, Calzada, Eyberg, McNeil, 2002)
References
Bates, S. L. (2005). Evidence-based family-school interventions with preschool children.
School Psychology Quarterly, 20, 352-370.
Epps, S. & Jackson, B. (2000). Empowered families, successful children: Early
intervention programs that work. American Psychological Association.
Hembree-Kigin, T.L. & McNeil, C.B. (1995). Parent-Child Interaction Therapy. New York:
Plenum Press.
Herschell, A. D., Calzada, E. J., Eyberg, S. M., & McNeil, C. B. (2002). Parent child
interaction therapy: New directions in research. Cognitive and Behavioral Practice, 9, 9-16.
Jacob-Timm, S. & Hartshorne, T. S. (1998). Ethics and law for school psychologists (3rd ed.).
New York: Wiley & Sons.
McDiarmid, M. D. & Bagner, D. M. (2005). Parent-child interaction therapy for children
with disruptive behavior and developmental disabilities. Education and Treatment of
Children, 28, 130-141.