Transcript A Good Tree Bearing New Fruit: Alternate Formats of PCIT

A Good Tree Bearing New Fruit:
Alternate Formats of PCIT
Larissa N. Niec
Central Michigan University
Branches for us to climb…
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Overview of the core components of PCIT
New questions to be answered
Review of alternate PCIT formats
Project HOPE at CMU
Questions still to be answered
In the beginning there was
the seed of PCIT…
Key, innovative features
• parent and child both in sessions
• active practice
• live coaching/immediate feedback
• 2 components –
– relationship enhancement and appropriate
discipline
• assessment driven – coding, weekly,
goal-focused
And it grew…
• Reduction in child disruptive behaviors to
WNL.
• Increase in parent positive verbal interaction
& discipline strategies
• Generalization of gains to school setting
• Generalization to untreated siblings
• Maintenance of tx gains up to 6 years post
New questions sprouted…
• Can we implement PCIT effectively in
settings other than the clinic?
• Is PCIT effective if we alter the amount of
therapist-client contact?
• Can we deliver PCIT in ways that
overcome additional treatment barriers?
Branches stretched in
different directions
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Setting changes
Abbreviated formats
Developmental innovations
Delivery format changes
Setting Changes
• School
– U.S. Preschoolers (McIntosh, Rizza, & Bliss,
2000; Filcheck, McNeil, Greco, & Bernard,
2004)
– Norwegian kindergartens (Kvarum, 2006)
• Home
– (Ware, 2006)
Teacher-Child Interaction
Therapy (TCIT)
• Child age range: Preschool
• Dx population: Disruptive behavior
• Tx Goals: Consistent with standard PCIT
• Research: single case study (McIntosh, et
al., 2000), ABACC’ classroom design
(Filcheck, et al., 2004)
Modifications for TCIT
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Teacher trained instead of parent
Didactic sessions as for PCIT
Coaching outside and inside classroom
From single to multiple children
Immediate feedback in classroom for 2
days of CDI and PDI
• Training time 11.5 hours
• Behavioral Assessment – components of
SOCS & DPICS
Abbreviated Formats
• Brief PCIT (Nixon, Sweeney, Erickson, &
Touyz, 2003, 2004)
• Foster Parent Workshop (McNeil,
Herschell, Gurwitch, & Clemens-Mowrer,
2005)
Brief PCIT
• Child age range: 3-5 years
• Dx population: Disruptive behavior disorders
• Tx goals: consistent with standard PCIT in a
theoretically more cost effective format
• Research: RCT with 1 & 2 year follow-up
(N=54)
Modifications for Brief PCIT
• Focus on same skills - CDI & PDI
• Taped didactic sessions watched at home
• 5 clinic coaching sessions alternated with
5 phone sessions
• Time to administer = 9.5 hours
(vs. 15.5 standard PCIT)
Foster Parent Workshop
• Child age range: 2-8 years
• Dx population:
foster parents
• Tx goals: consistent with PCIT & training
for foster parents
• Research: 1 pre-post study
Modifications for Workshop
• Two days of training –
– 1 day didactic, 1 day coaching/planning
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Group format
Role play of skills
Foster parents observe each other
No home practice during training
No DPICS coding
Coaching time = 1.5 hours vs. 7 hours standard
Developmental Innovations
• PCIT with younger children
– Parent-Child Attunement Therapy
• PCIT with older children
– Alternatives for Families
Younger Children: PCAT
(Dombrowski, Timmer, Blacker, & Urquiza, 2005)
• Child age range:
12-30 months
• Dx population:
maltreated toddlers
• Tx goals:
• increase appropriate parenting
• strengthen caregiver-child relationship,
• Research: Single case study
PCIT with Older Children
(Chaffin, et al., 2004)
• Child age range: 4-12 years
• Dx population:
physically abused
• Tx goals: consistent with standard PCIT
• Research: RCT N=110 families
Service Delivery Format
• Group PCIT with families with CPS
involvement (Brestan, 2006)
• Group PCIT with children with disruptive
behavior disorders (Niec, et al., 2004;
Project HOPE)
Project HOPE:
Helping Out Parents Effectively*
Central Michigan University
• NIMH-funded pilot of group PCIT
• Sample: 3-6 year olds with ODD/CD dx
*NIMH 1R34MH070483-01A1
Big Four: Critical Questions
1. Does the new format include the core
components of PCIT?
2. Is it driven by a theoretical approach
consistent with the underpinnings of PCIT?
3. Does it have something additional to offer?
4. Is the new format effective?
1. Does group PCIT include the
core PCIT components?
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Live coaching
Immediate feedback
Assessment driven
CDI
PDI
Homework
2. Is group PCIT driven by a
theoretical approach
consistent with standard
PCIT?
• Attachment theory
– Focus remains on the parent-child dyad
• Social learning theory
– Therapists and other parents model
appropriate behaviors
– Social reinforcement from peers
Modifications for Group
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Initial cohesion-building session
All parents observe coaching
Parents code each other w DPICS
Group peer feedback
Individual 1st PDI session
Children’s group – free play w CDI
3. Does group PCIT have
something additional to offer?
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Cost-effectiveness
Treatment accessibility
Parent-to-parent support
Breaking barriers of stigma
Social reinforcement from peers
– Increase adherence
– Decrease attrition
4. Is group PCIT effective?
• Pilot data show reductions in child
behavior problems and parent stress.
• Ongoing 3-year NIMH-funded pilot study
• Random assignment to group or
individual PCIT: first two groups finishing
now.
PDI session during group
• Fifth PDI coaching (of 6)
• Single parent with 4-yr-old twins w ODD
• Need: to manage time out with both
children present
Good group cohesion leads
to…
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Parent support in group!
Car pooling!
PCIT Picnics!
Homework reminders!
Extra support during
difficult PDI sessions!
Forbidden Fruit?
Need for caution!
• Modified formats have only preliminary
evidence
• Consider appropriateness of populations
to modification
• Answer Big Four questions
Future fruit to be
harvested…
Mindfulness?
Attributions?
More motivation
interventions?
Thank you to all the clinicians
and research assistants in the
CMU PCIT Lab!
PCIT